65 - Preissitzung
16. Mai 2019, 13:45 - 15:15, Sopra 3, 4. OG
Defining major surgery: A delphi consensus among European Surgical Association (ESA) members
D. Martin, S. Mantziari, N. Demartines, M. Hübner, Presenter: D. Martin (Lausanne)
Major surgery is a term frequently used but poorly defined. The aim of the present study was to reach a consensus to an acceptable definition of major surgery, with clear criteria as defined by European Surgical Association (ESA) members.
A 3-round Delphi process was performed and questionnaires were delivered via an online platform. All ESA members (n=305) 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 round 2 and 3. Closed-ended questions in round 2 and 3 were either binary or statements to be rated on a Likert scale ranging from 1 to 5 (1: strong disagreement, 5: strong agreement). Participants were sent 3 reminders at 2-week intervals for each round. 70% of agreement was considered to indicate consensus.
105 invited ESA members answered to the first round, and 79 members completed the surveys 2 and 3 (final response rate 26%). Mean age was 59 years (SD 9), 99% were males, a majority was specialized in HPB surgery (65%), had >20 years of practice (87%) and in university hospitals (95%). No preoperative factor was retained to define the term major surgery. In contrast, vascular clampage/organ ischemia (87%), >10µg/min noradrenalin requirements (72%), intraoperative blood loss > 1000 ml (83%), perioperative blood transfusion > 2 red blood cell (71%) and operative time > 3 hours (75%) were all considered to be related with a major surgical procedure. Similarly, systemic inflammatory disease response was selected (75%) along with related biomarkers (C-reactiv protein: 87%, lactate: 89%), the need for intensive/intermediate care (80%), and important fluid resuscitation (75%). Consequences of major surgery were a high morbidity (>30% overall, >10% severe) and mortality (≥1%). Experts agreed that a major surgical procedure requires high expertise of the surgeon (91%), multidisciplinary work (87%), and the setting of a high-volume institution (84%).
ESA experts defined major surgery according to extent and complexity of the procedure, its pathophysiological consequences, and consecutive clinical outcomes. The term major surgery should be used only if these criteria are fulfilled.