Novel Textbook Outcomes following emergency laparotomy: Delphi exercise
Authors: Naumann David N , Bhangu Aneel , Brooks Adam , Martin Matthew , Cotton Bryan A , Khan Mansoor , Midwinter Mark J , Pearce Lyndsay , Bowley Douglas M , Holcomb John B , Griffiths Ewen A ,   BEACON Collaborative, Abu-Abeid Adam , Brooks Adam , Peckham-Cooper Adam , Dyas Adam R , Adeyeye Ademola , Dogjani Agron , Ball Alasdair C Y , Wolthuis Albert M , Quiroga-Garza Alejandro , Karamarkovic Aleksandar R , Giordano Alessio , Fuchs Alexander , Julianov Alexander , Phillips Alexander W , Zimmermann Alexander , Charalabopoulos Alexandros , Birkun Alexei A , Narvaez-Rojas Alexis Rafael , Guner Ali , Davis Amelia L , Vereczkei Andras , Balla Andrea , Celotti Andrea , Romanzi Andrea , Trombetta Andrea , Beggs Andrew D , Robertson Andrew G , Petrosoniak Andrew , Davies Andrew R , Becerra-Bolaños Ángel , Loria Anthony , Brillantino Antonio , Athanasiou Antonios , Isik Arda , Ioannidis Argyrios , Santos Ariel P , Saha Arin K , Vilches-Moraga Arturo , Choudhry Asad J , Tsuchiya Asuka , Smithers B Mark , Wijnhoven Bas P L , Keeler B D , De Simone Belinda , Birla Rodica , Mitra Biswadev , Atanasov Boyko Chavdarov , Badgwell Brian , Nolan Brodie , Cotton Bryan A , Kang Byung Hee , Duffy Caoimhe C , Ordoñez Carlos A , Gomes Carlos Augusto , Mueller Carmen L , Reinke Caroline E , Lebares Carter C , Hunter Catherine J , Villodre Celia , Guldogan Cem E , Seretis Charalampos , Adams Charles A , Pilgrim Charles H C , Varghese Chris , Owoo Christian , Meyhoff Christian S , Fleming Christina A , Stuart Christina M , Lewis-Lloyd Christopher A , McLaughlin Christopher J , Stevens Claire L , Graham Colin A , Magee Conor , Saunders David I , Yeh D Dante , Chan Daniel L , Felsenreich Daniel M , Holena Daniel N , Bawa Dauda , Bowrey David J , Naumann David N , Liu David S , Chan David S Y , Nag Deb Sanjay , Haddad Diane N , Corallino Diletta , Damaskos Dimitrios , Moris Dimitrios , Schizas Dimitrios , Korkolis Dimitris P , Bagaria Dinesh Kumar , Adamovich Dmitry Mikhailovich , Colquhoun Douglas A , Bowley Douglas M , Singhal Dinesh , Siddaiah-Subramanya Manjunath , Kapoor Rohit , Wyncoll Duncan , Hai Duong Van , Avest Ewoud Ter , Muttillo Edoardo Maria , Picetti Edoardo , Kelly Edward , Baili Efstratia , Pinto Eleonora , Colak Elif , Dixon Elijah , Reitano Elisa , Sultana Emiko , Mills Emily C , Ley Eric J , Osterman Erik , Pivalizza Evan G , Tokidis Evripidis , Griffiths Ewen A , Ezanno Anne-Cécile , Catena Fausto , Pederiva Federica , Coccolini Federico , Nickel Felix , Agresta Ferdinando , Tovar Fernando Navarro , Abu-Zidan Fikri M , Brzeszczyński Filip , El Boghdady Michael , Takeda Flavio Roberto , Fleres Francesco , Pecchini Francesca , Carrano Francesco Maria , Pata Francesco , Mulita Francesk , Klevebro Fredrik , Rodrigues Gabriel , Gallo Gaetano , Poillucci Gaetano , Bass Gary Alan , Aggarwal Geeta , Perrone Gennaro , Roberts Geoffrey , Koukoulis Georgios , Zacharis Georgios , Baiocchi Gian Luca , Pellino Gianluca , Lisi Giorgio , Dapri Giovanni , Brisinda Giuseppe , Augustin Goran , Christodoulidis Grigorios , Imbriaco Guglielmo , Ducarme Guillaume , Rasa H Kemal , Hamer Peter W , Lederhuber Hans , Plaudis Haralds , Uchino Hayaki , Beji Hazem , Ferguson Henry J M , Cohen Hugo M L , Wilson Iain , Kryvoruchko Igor A , Kuitunen Ilari , Benzoni Ilaria , Merlini Ilenia , Ose Ilze , Wani Imtiaz , Gockel Ines , Negoi Ionut , Gribovskaja-Rupp Irena , Tomasi Ivan , Olaoye Iyiade Olatunde , Kenington J Cleo , Roth J Scott , Rosenberg Jacob , Viganò Jacopo , Williamson James Matthew Lloyd , De Waele Jan J , Smith Jason E , Nahmias Jeffry , Stevens Jennifer L , Rickard Jennifer , Mah Jin Jiun , Waalwijk Job F , Yuval Jonathan B , Kauppila Joonas H , Cuschieri Joseph , Brown Joshua B , Rivas Juan Gomez , Emamaullee Juliet , Lasithiotakis K , McKenzie Katherine , Matsushima Kazuhide , Koivusalo A I , Almond L Max , Konge Lars , Jorgensen Lars N , Genser Laurent , Napolitano Lena M , Brown Leo R , Kaplan Lewis J , Degrate Luca , Bonavina Luigi , Moore Lynne , Gachabayov Mahir , Dornseifer Mamun David , Siddaiah-Subramanya Manjunath , Abdulshafea Mansour , Ribeiro Junior Marcelo A F , Migliore Marcello , Ceresoli Marco , Clementi Marco , Scarpa Marco , Olausson Maria , Sousa Mariana R F , Giuffrida Mario , D'Oria Mario , Pacilli Mario , Czerny Martin , Reichert Martin , Rutegård Martin , Bahreini Maryam , Lee Matthew J , Martin Matthew J , Tolonen Matti , Fehervari Matyas , Rho Maurizio , Podda Mauro , Léger Maxime , Frountzas Maximos , Chisthi Meer M , Lewis Meghan R , Bérubé Mélanie , Oliveira-Cunha Melissa , Marsden Max E R , Tez Mesut , Piccoli Micaela , Bath Michael F , Flanagan Michael , Gottlieb Michael , Pearl Michael L , Achiam Michael P , Swart Michael , Ukkonen Mika , Bala Miklosh , Ebrahim Mohamed , AlAli Mohammed N , Ortenzi Monica , Ghalleb Montassar , Hylander Møller Morten , Iqbal Muhammad R , Ali Muhammed A , Tarazi Munir , Newton Nicholas J , Hanna Nader M , Henriksen Nadia A , Blencowe Natalie S , Merrett Neil , Welch Neil T , Colucci Nicola , de'Angelis Nicola , Latronico Nicola , Werner Nicole L , Martin Niels D , Machairas Nikolaos , Bugaev Nikolay , Pang Ning Qi , Obinwa Obinna , Akanji Onigbinde Oluwanisola , Kapsampelis Panagiotis , De Nardi Paola , Vincenzi Paolo , Kohan Patricio Lamoza , Pucher Philip H , Herrod Philip J J , CHIU Philip W Y , Marzuillo Pierluigi , Sileri Pierpaolo , Fransvea Pietro , Navsaria Pradeep H , Valentin Predescu Dragos , Bakx Roel , Choron Rachel L , Gupta Rahul , Ivatury Rao R , Diaz Raquel , Bradley Rebecca Anne , Elisa Reitano , Palacios Huatuco René M , Shahriarirad Reza , Rattan Rishi , Karmy-Jones Riyad , Sawyer Robert G , Coelen Robert J S , Cirocchi Roberto , Gelbard Rondi B , Zakeri Roxanna , Farinha Rui , Schols Rutger M , Dumas Ryan P , Saverio Salomone Di , Bandyopadhyay Samik Kumar , Delibegovic Samir , Stevens Sean , Navarro Sergio M , Chatterjee Shamita , Petousis Stamatios , Gourgiotis Stavros , Streit Stephanie M , Baral Suman , Karna Sunaina T , Moug Susan , Yoong Susan , Gisbertz Suzanne S , Kheirbek Tareq , Jeremy Teoh Yuen-Chun , Duane Therese M , Jensen Thomas Korgaard , Bright Tim , Hardcastle Timothy Craig , Tania Triantafyllou , Nikolian Vahagn C , Bianchi Valentina , Kong Victor , Trapani Vincenzo , Shelat Vishal G , Mani Vishnu R , Khokha Vladimir M , Yang Wah , Al-Khyatt Waleed , Lam Yick Ho , Kijima Yu , Cui Yunfeng , Perkins Zane B , Demetrashvili Zaza , Ng Zi Qin 
Published: January 2024

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.