Novel Textbook Outcomes following emergency laparotomy: Delphi exercise

Abstract

Background Textbook outcomes are composite outcome measures that reflect the ideal overall experience for patients. There are many of these in the elective surgery literature but no textbook outcomes have been proposed for patients following emergency laparotomy. The aim was to achieve international consensus amongst experts and patients for the best Textbook Outcomes for non-trauma and trauma emergency laparotomy. Methods A modified Delphi exercise was undertaken with three planned rounds to achieve consensus regarding the best Textbook Outcomes based on the category, number and importance (Likert scale of 1–5) of individual outcome measures. There were separate questions for non-trauma and trauma. A patient engagement exercise was undertaken after round 2 to inform the final round. Results A total of 337 participants from 53 countries participated in all three rounds of the exercise. The final Textbook Outcomes were divided into ‘early’ and ‘longer-term’. For non-trauma patients the proposed early Textbook Outcome was ‘Discharged from hospital without serious postoperative complications (Clavien–Dindo ≥ grade III; including intra-abdominal sepsis, organ failure, unplanned re-operation or death). For trauma patients it was ‘Discharged from hospital without unexpected transfusion after haemostasis, and no serious postoperative complications (adapted Clavien–Dindo for trauma ≥ grade III; including intra-abdominal sepsis, organ failure, unplanned re-operation on or death)’. The longer-term Textbook Outcome for both non-trauma and trauma was ‘Achieved the early Textbook Outcome, and restoration of baseline quality of life at 1 year’. Conclusion Early and longer-term Textbook Outcomes have been agreed by an international consensus of experts for non-trauma and trauma emergency laparotomy. These now require clinical validation with patient data.

Navigating Life Post-emergency Laparotomy: A Narrative Review on Quality-of-Life Outcomes

“…Short-term physical recovery following emergency laparotomy may exhibit variability, as certain patients may encounter a decline in their physical well-being after surgery. Factors such as complications related to stoma management, postoperative morbidity, and alterations in employment status have emerged as noteworthy contributors to the influence on physical health outcomes [23,24]. Furthermore, complications such as changes in bowel habits and issues with stoma management can exert a considerable social and psychological toll on patients, thereby impacting their short-term physical recuperation [24].…”

“…Factors such as complications related to stoma management, postoperative morbidity, and alterations in employment status have emerged as noteworthy contributors to the influence on physical health outcomes [23,24]. Furthermore, complications such as changes in bowel habits and issues with stoma management can exert a considerable social and psychological toll on patients, thereby impacting their short-term physical recuperation [24]. Addressing these factors and delivering comprehensive postoperative care are essential steps to optimize short-term physical recovery outcomes for individuals undergoing emergency laparotomy.…”