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

David Martin; Styliani Mantziari; the ESA Study Group; 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 Rituerto; Pierre Alain Clavien; Nicolo De Manzini; George Decker; Cornelis Hc Dejong; Christos Dervenis; Olivier Farges; Joan Figueras; Abraham Louis Fingerhut; Helmut Friess; Olivier Glehen; Michael Gnant; Christian Gutschow; Dieter Hahnloser; Bertil Hamberger; Jacob Frans Hamming; Arnulf H. Hölscher; Jakob R. Izbicki; Sven Jonas; Aleksandar Karamarkovic; Henrik Kehlet; Ari Kalevi Leppäniemi; Jan Lerut; Pål Dag Line; J. Peter A. Lodge; Jonathan Larmonth Meakins; Marco Montorsi; Philippe Nafteux; Peter Naredi; Attila Oláh; Yves Panis; Fernando Pardo; Rowan W. Parks; Sergio Pedrazzoli; Bas Wijnhoven

doi:10.1007/s00268-020-05476-4

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

David Martin, Styliani Mantziari, the ESA Study Group, 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 Rituerto, Pierre Alain Clavien, Nicolo De Manzini, George DeckerCornelis Hc Dejong, Christos Dervenis, Olivier Farges, Joan Figueras, Abraham Louis Fingerhut, Helmut Friess, Olivier Glehen, Michael Gnant, Christian Gutschow, Dieter Hahnloser, Bertil Hamberger, Jacob Frans Hamming, Arnulf H. Hölscher, Jakob R. Izbicki, Sven Jonas, Aleksandar Karamarkovic, Henrik Kehlet, Ari Kalevi Leppäniemi, Jan Lerut, Pål Dag Line, J. Peter A. Lodge, Jonathan Larmonth Meakins, Marco Montorsi, Philippe Nafteux, Peter Naredi, Attila Oláh, Yves Panis, Fernando Pardo, Rowan W. Parks, Sergio Pedrazzoli, Bas Wijnhoven

^*Corresponding author for this work

Surgery

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Abstract

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.

Original language	English
Pages (from-to)	2211-2219
Number of pages	9
Journal	World Journal of Surgery
Volume	44
Issue number	7
DOIs	https://doi.org/10.1007/s00268-020-05476-4
Publication status	Published - Jul 2020

Bibliographical note

Publisher Copyright:
© 2020, Société Internationale de Chirurgie.

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Martin, D., Mantziari, S., the ESA Study Group, Demartines, N., Hübner, M., Bismuth, H., Sarr, M. G., Strasberg, S. M., Wexner, S. D., Adham, M., Altomare, D. F., Andersson, R., Bechstein, W., Biondo, S., Bockhorn, M., Bonavina, L., Rituerto, D. C., Clavien, P. A., De Manzini, N., ... Wijnhoven, B. (2020). Defining Major Surgery: A Delphi Consensus Among European Surgical Association (ESA) Members. World Journal of Surgery, 44(7), 2211-2219. https://doi.org/10.1007/s00268-020-05476-4

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title = "Defining Major Surgery: A Delphi Consensus Among European Surgical Association (ESA) Members",

abstract = "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.",

author = "David Martin and Styliani Mantziari and {the ESA Study Group} and Nicolas Demartines and Martin H{\"u}bner and Henri Bismuth and Sarr, {Michael G.} and Strasberg, {Steven M.} and Wexner, {Steven D.} and Mustapha Adham and Altomare, {Donato F.} and Roland Andersson and Wolf Bechstein and Sebastiano Biondo and Maximilian Bockhorn and Luigi Bonavina and Rituerto, {Daniel Casanova} and Clavien, {Pierre Alain} and {De Manzini}, Nicolo and George Decker and Dejong, {Cornelis Hc} and Christos Dervenis and Olivier Farges and Joan Figueras and Fingerhut, {Abraham Louis} and Helmut Friess and Olivier Glehen and Michael Gnant and Christian Gutschow and Dieter Hahnloser and Bertil Hamberger and Hamming, {Jacob Frans} and H{\"o}lscher, {Arnulf H.} and Izbicki, {Jakob R.} and Sven Jonas and Aleksandar Karamarkovic and Henrik Kehlet and Lepp{\"a}niemi, {Ari Kalevi} and Jan Lerut and Line, {P{\aa}l Dag} and Lodge, {J. Peter A.} and Meakins, {Jonathan Larmonth} and Marco Montorsi and Philippe Nafteux and Peter Naredi and Attila Ol{\'a}h and Yves Panis and Fernando Pardo and Parks, {Rowan W.} and Sergio Pedrazzoli and Bas Wijnhoven",

note = "Publisher Copyright: {\textcopyright} 2020, Soci{\'e}t{\'e} Internationale de Chirurgie.",

year = "2020",

month = jul,

doi = "10.1007/s00268-020-05476-4",

language = "English",

volume = "44",

pages = "2211--2219",

journal = "World Journal of Surgery",

issn = "0364-2313",

publisher = "John Wiley & Sons Inc.",

number = "7",

}

Martin, D, Mantziari, S, the ESA Study Group, Demartines, N, Hübner, M, Bismuth, H, Sarr, MG, Strasberg, SM, Wexner, SD, Adham, M, Altomare, DF, Andersson, R, Bechstein, W, Biondo, S, Bockhorn, M, Bonavina, L, Rituerto, DC, Clavien, PA, De Manzini, N, Decker, G, Dejong, CH, Dervenis, C, Farges, O, Figueras, J, Fingerhut, AL, Friess, H, Glehen, O, Gnant, M, Gutschow, C, Hahnloser, D, Hamberger, B, Hamming, JF, Hölscher, AH, Izbicki, JR, Jonas, S, Karamarkovic, A, Kehlet, H, Leppäniemi, AK, Lerut, J, Line, PD, Lodge, JPA, Meakins, JL, Montorsi, M, Nafteux, P, Naredi, P, Oláh, A, Panis, Y, Pardo, F, Parks, RW, Pedrazzoli, S & Wijnhoven, B 2020, 'Defining Major Surgery: A Delphi Consensus Among European Surgical Association (ESA) Members', World Journal of Surgery, vol. 44, no. 7, pp. 2211-2219. https://doi.org/10.1007/s00268-020-05476-4

TY - JOUR

T1 - Defining Major Surgery

T2 - A Delphi Consensus Among European Surgical Association (ESA) Members

AU - Martin, David

AU - Mantziari, Styliani

AU - the ESA Study Group

AU - Demartines, Nicolas

AU - Hübner, Martin

AU - Bismuth, Henri

AU - Sarr, Michael G.

AU - Strasberg, Steven M.

AU - Wexner, Steven D.

AU - Adham, Mustapha

AU - Altomare, Donato F.

AU - Andersson, Roland

AU - Bechstein, Wolf

AU - Biondo, Sebastiano

AU - Bockhorn, Maximilian

AU - Bonavina, Luigi

AU - Rituerto, Daniel Casanova

AU - Clavien, Pierre Alain

AU - De Manzini, Nicolo

AU - Decker, George

AU - Dejong, Cornelis Hc

AU - Dervenis, Christos

AU - Farges, Olivier

AU - Figueras, Joan

AU - Fingerhut, Abraham Louis

AU - Friess, Helmut

AU - Glehen, Olivier

AU - Gnant, Michael

AU - Gutschow, Christian

AU - Hahnloser, Dieter

AU - Hamberger, Bertil

AU - Hamming, Jacob Frans

AU - Hölscher, Arnulf H.

AU - Izbicki, Jakob R.

AU - Jonas, Sven

AU - Karamarkovic, Aleksandar

AU - Kehlet, Henrik

AU - Leppäniemi, Ari Kalevi

AU - Lerut, Jan

AU - Line, Pål Dag

AU - Lodge, J. Peter A.

AU - Meakins, Jonathan Larmonth

AU - Montorsi, Marco

AU - Nafteux, Philippe

AU - Naredi, Peter

AU - Oláh, Attila

AU - Panis, Yves

AU - Pardo, Fernando

AU - Parks, Rowan W.

AU - Pedrazzoli, Sergio

AU - Wijnhoven, Bas

PY - 2020/7

Y1 - 2020/7

N2 - 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.

AB - 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.

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U2 - 10.1007/s00268-020-05476-4

DO - 10.1007/s00268-020-05476-4

M3 - Article

C2 - 32172309

AN - SCOPUS:85081720196

SN - 0364-2313

VL - 44

SP - 2211

EP - 2219

JO - World Journal of Surgery

JF - World Journal of Surgery

IS - 7

ER -

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

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