AimsTo identify and understand the different approaches to local consensus discussions that have been used to implement perioperative pathways for common elective surgeries.DesignSystematic review.Data SourcesFive databases (MEDLINE, CINAHL, EMBASE, Web of Science and the Cochrane Library) were searched electronically for literature published between 1 January 2000 and 6 April 2023.MethodsTwo reviewers independently screened studies for inclusion and assessed quality. Data were extracted using a structured extraction tool. A narrative synthesis was undertaken to identify and categorise the core elements of local consensus discussions reported. Data were synthesised into process models for undertaking local consensus discussions.ResultsThe initial search returned 1159 articles after duplicates were removed. Following title and abstract screening, 135 articles underwent full‐text review. A total of 63 articles met the inclusion criteria. Reporting of local consensus discussions varied substantially across the included studies. Four elements were consistently reported, which together define a structured process for undertaking local consensus discussions.ConclusionsLocal consensus discussions are a common implementation strategy used to reduce unwarranted clinical variation in surgical care. Several models for undertaking local consensus discussions and their implementation are presented.Implications for the Profession and/or Patient CareAdvancing our understanding of consensus building processes in perioperative pathway development could be significantly improved by refining reporting standards to include criteria for achieving consensus and assessing implementation fidelity, alongside advocating for a systematic approach to employing consensus discussions in hospitals.ImpactThese findings contribute to recognised gaps in the literature, including how decisions are commonly made in the design and implementation of perioperative pathways, furthering our understanding of the meaning of consensus processes that can be used by clinicians undertaking improvement initiatives.Reporting MethodThis review adheres to the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) guidelines.No patient or public contribution.Trial Registration: CRD42023413817
