학술논문
Defining Major Surgery: A Delphi Consensus Among European Surgical Association (ESA) Members
Document Type
Author
Martin, David; Mantziari, Styliani; Demartines, Nicolas; Hübner, Martin; Bismuth, Henri; Sarr, Michael G.; Strasberg, Steven M.; Wexner, Steven D.; Adham, Mustapha; Altomare, Donato F.; Andersson, Roland; Bechstein, Wolf; Biondo, Sebastiano; Bockhorn, Maximilian; Bonavina, Luigi; Rituerto, Daniel Casanova; Clavien, Pierre Alain; De Manzini, Nicolo; Decker, George; Dejong, Cornelis Hc; Dervenis, Christos; Farges, Olivier; Figueras, Joan; Fingerhut, Abraham Louis; Friess, Helmut; Glehen, Olivier; Gnant, Michael; Gutschow, Christian; Hahnloser, Dieter; Hamberger, Bertil; Hamming, Jacob Frans; Hölscher, Arnulf H.; Izbicki, Jakob R.; Jonas, Sven; Karamarkovic, Aleksandar; Kehlet, Henrik; Leppäniemi, Ari Kalevi; Lerut, Jan; Line, Pål Dag; Lodge, J. Peter A.; Meakins, Jonathan Larmonth; Montorsi, Marco; Nafteux, Philippe; Naredi, Peter, 1955; Oláh, Attila; Panis, Yves; Pardo, Fernando; Parks, Rowan W.; Pedrazzoli, Sergio; Pessaux, Patrick; Marques, Hugo Pinto; Poggioli, Gilberto; Popescu, Irinel; Puolakkainen, Pauli Antero; Ramia Angel, José M.; Rasanen, Jari; Reynolds, John Vincent; Rosati, Riccardo; Saeger, Hans Detlev; Schneeberger, Stefan; Schneider, Paul M.; Søreide, Kjetil; Stippel, Dirk; Toso, Christian; Tuech, Jean Jacques; Tukiainen, Erkki Juhani; Van Hillegersberg, Richard; Wijnhoven, Bas; Winter, Desmond C.; Zaninotto, Giovanni
Source
World Journal of Surgery. 44(7):2211-2219
Subject
Language
English
ISSN
03642313
14322323
14322323
Abstract
© 2020, Société Internationale de Chirurgie. Background: Major 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). Methods: A 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. Results: Out 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%). Conclusion: ESA experts defined major surgery according to extent and complexity of the procedure, its pathophysiological consequences and consecutive clinical outcomes.