Defining Major Surgery: A Delphi Consensus Among European Surgical Association (ESA) Members

• DOI: 10.1007/s00268-020-05476-4
• Publication Date: 2020-03-14T17:02:36Z
• Authors: David Martin; Styliani Mantziari; Nicolas Demartines; Martin Hübner; ; Henri Bismuth; Michael G. Sarr; Steven M. Strasberg; Steven D. Wexner; Mustapha Adham; Donato F. Altomare; Roland Andersson; Wolf Bechstein; Sebastiano Biondo; Maximilian Bockhorn; Luigi Bonavina; Daniel Casanova R...; Pierre‐Alain Clavien; Nicolo De Manzini; George Decker; Cornelis HC Dejong; Christos Dervenis; Olivier Farges; Joan Figueras; Abraham Louis Fin...; Helmut Friess; Olivier Glehen; Michael Gnant; Christian Gutschow; Dieter Hahnloser; Bertil Hamberger; Jacob Frans Hamming; Arnulf H. Hölscher; Jakob R. Izbicki; Sven Jonas; Aleksandar Karama...; Henrik Kehlet; Ari Kalevi Leppän...; Jan Lerut; Pål‐Dag Line; J. Peter A. Lodge; Jonathan Larmonth...; Marco Montorsi; Philippe Nafteux; Peter Naredi; Attila Oláh; Yves Panis; Fernando Pardo; Rowan W. Parks; Sergio Pedrazzoli; Patrick Pessaux; Hugo Pinto Marques; Gilberto Poggioli; Irinel Popescu; Pauli Antero Puol...; José M. Ramia Angel; Jari Rasanen; John Vincent Reyn...; Riccardo Rosati; Hans‐Detlev Saeger; Stefan Schneeberger; Paul M. Schneider; Kjetil Søreide; Dirk Stippel; Christian Toso; Jean‐Jacques Tuech; Erkki Juhani Tuki...; Richard Van Hille...; Bas Wijnhoven; Desmond C. Winter; Giovanni Zaninotto
• Keywords: Male; Consensus; Aged; Consensus; Europe; Humans; Male; Middle Aged; Societies, Medical; Surgeons; Surgical Procedures, Operative; Delphi Technique; Delphi Technique; 610 Medicine & health; MORBIDITY; 03 medical and health sciences; COLORECTAL SURGERY; 0302 clinical medicine; Medical; INFECTION; major surgery; Delphi consensus definition; info:eu-repo/classification/ddc/617; Humans; Operative / methods; Societies, Medical; 10217 Clinic for Visceral and Transplantation Surgery; Aged; Surgeons; COMPLICATIONS; Delphi consensus definition; Surgical Procedures; [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology; ddc:617; INTERNATIONAL CONSENSUS; MORTALITY; Middle Aged; CANCER SURGERY; major surgery; 2746 Surgery; 3. Good health; Europe; Surgical Procedures, Operative; Surgery; HEALTH; Societies; [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology

AbstractBackgroundMajor surgery is a term frequently used but poorly defined. The aim of the present study was to reach a consensus in the definition of major surgery within a panel of expert surgeons from the European Surgical Association (ESA).MethodsA 3‐round Delphi process was performed. All ESA members were invited to participate in the expert panel. In round 1, experts were inquired by open‐ and closed‐ended questions on potential criteria to define major surgery. Results were analyzed and presented back anonymously to the panel within next rounds. Closed‐ended questions in round 2 and 3 were either binary or statements to be rated on a Likert scale ranging from 1 (strong disagreement) to 5 (strong agreement). Participants were sent 3 reminders at 2‐week intervals for each round. 70% of agreement was considered to indicate consensus.ResultsOut of 305 ESA members, 67 (22%) answered all the 3 rounds. Significant comorbidities were the only preoperative factor retained to define major surgery (78%). Vascular clampage or organ ischemia (92%), high intraoperative blood loss (90%), high noradrenalin requirements (77%), long operative time (73%) and perioperative blood transfusion (70%) were procedure‐related factors that reached consensus. Regarding postoperative factors, systemic inflammatory response (76%) and the need for intensive or intermediate care (88%) reached consensus. Consequences of major surgery were high morbidity (>30% overall) and mortality (>2%).ConclusionESA experts defined major surgery according to extent and complexity of the procedure, its pathophysiological consequences and consecutive clinical outcomes.