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A Delphi process to define medical reporting outcomes for urgent surgical pathways - 09/05/25

Doi : 10.1016/j.accpm.2025.101529 
Thomas Botrel a, , Paul S. Myles b, Emmanuel Futier c, Delphine Garrigue d, Max Bell e, Timothy Egan f, Luiz Marcelo Malbouisson g, Duminda N. Wijeysundera h, Brian O’Gara i, Mathieu Raux j, Jean-Michel Constantin a

On behalf of the GRO2M-1 study group

Thomas BOTREL, Paul S. MYLES, Emmanuel FUTIER, Delphine GARRIGUE, Max BELL, Timothy EGAN, Luiz Marcelo MALBOUISSON, Duminda N. WIJEYSUNDERA, Brian O’Gara, Mathieu RAUX, Jean-Michel CONSTANTIN, Stéphane Bar, Ahmed W.H. Barazanchi, Marie Borel, Guillaume Bouhours, Wendy Brown, Donal J. Buggy, Benjamin E. Byrne, Marco Ceresoli, Michelle Chew, Sharfuddin Chowdhury, Mirjana Cihoric, Jean-Stéphane David, Belinda De Simone, Pauline Devauchelle, Candice Downey, Christophe Alain Fehlmann, Tobias Gauss, Laurent G. Glance, Russell L. Gruen, Joaquim M. Havens, Shaman Jhanji, Stephan Dominik Kurz, Maxime Le Courtois Du Manoir, Antoine Lefevre, Valentin Lefrançois, Ari Leppaniemi, Daniel McIsaac, C.M. Oliver, Julien Pottecher, Deb Sanjay, Luciana Stefani, Kathleen B. To, M. Vester-Andersen, Joyce Yeung, Ben L. Zarzaur

a Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, 43-87 Bd de l'Hôpital, 75013, Paris, France 
b Department of Anesthesiology and Perioperative Medicine, Alfred Hospital, Monash University, Melbourne, Australia 
c Département Anesthésie Réanimation et Médecine Périopératoire, Hôpital Estaing, Centre Hospitalier Universitaire Clermont-Ferrand et Université Clermont Auvergne, CNRS, Inserm U-1103, Clermont-Ferrand, France 
d Department of Anesthesiology and Critical Care, Lille University Hospital, 59000, Lille, France 
e Department of Perioperative Medicine and Intensive Care (PMI), Karolinska University Hospital, Stockholm, Sweden 
f Department of Anaesthesia and Perioperative Medicine, Royal London Hospital, Barts Health NHS. Trust, London, United Kingdom 
g Discipline of Anesthesiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil 
h Department of Anesthesiology and Pain Medicine, University of Toronto, Department of Anesthesia, Unity Health Toronto - St. Michael's Hospital, Toronto, ON, Canada 
i Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States 
j Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département d'Anesthésie Réanimation, 43-87 Bd de l'Hôpital, F-75013 Paris, France 

Corresponding author.

Abstract

Background

As the demand for high-quality healthcare grows, there is a pressing need for comprehensive methods to assess the quality of hospital care. Lack of standardization makes it difficult to compare urgent surgical outcomes across studies. Our group used a modified Delphi methodology to define the outcomes that should be reported or compared when evaluating urgent surgical care.

Methods

This three-round Delphi process took place from May to October 2024. It was conducted with an international panel of medico-surgical experts from 16 countries. We aimed to select, based on a 2-level consensus assessment, reporting outcomes for urgent surgical pathways.

Results

Initially, 87 items were classified under 8 headings. 26 outcomes were selected after the second Delphi round. A third round was required to validate 3 additional outcomes. Among the selected outcomes were in-hospital or 30-day mortality, 15 items addressing perioperative morbidity, as well as factors related to the patient journey: preoperative (surgical waiting time), intraoperative (surgical bleeding), and postoperative aspects (9 items selected). Notably, no items from the ‘patient satisfaction’ and ‘medico-economics’ headings were retained. Panelists deemed it essential to use multi-criteria outcomes (i.e., combining items from the 8 headings) to evaluate urgent surgical care pathways.

Conclusions

A set of 29 relevant outcomes will help to develop a more comprehensive approach for urgent surgical care evaluation. It enables the development of new prioritization policies and a better study of outcomes for urgent surgeries. It is worth noting the lack of economic criteria and patient satisfaction measures.

Il testo completo di questo articolo è disponibile in PDF.

Keywords : Surgical pathways, Urgent surgery, Surgical outcome, Prioritization evaluation, Pathway optimization, Delphi methodology


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