Development of a core outcome set of quality indicators for enhanced recovery after surgery in minimally invasive cardiac heart valve surgery by interprofessional Delphi consensus

Abstract

Objectives: A core outcome set (COS) giving indicators of the quality of the process for minimally invasive valve surgery embedded into enhanced recovery after surgery (ERAS) protocols should be developed.

Methods: Using web-based questionnaires, a Delphi process with three rounds was conducted from January to December 2022. Prior to the rounds, a systematic database search was performed identifying potential quality parameters. Experts for the panel were selected reflecting the interprofessional nature of the ERAS protocol. In the first round, participants could make suggestions of indicators in the pre-, intra- or postoperative and rehabilitative phase. These suggestions form together with the indicators of the literature a first indicator list. In the second round, participants could rate the relevance of the indicators resulting in a condensed indicator list. The third round was performed for further condensation based on importance ranking of the remaining indicators.

Results: Three studies could be included in the systematic literature search providing a list of 22 indicators. Twenty-one experts participated in the Delphi survey. The experts named 315 indicators in the first round. After condensation in two further rounds, the final COS consisted of 24 indicators in the categories structure, process, outcome and complications.

Conclusions: A consensual minimum set of quality measurements during pre-, intra- and postoperative and rehabilitation phase for patients with minimally invasive heart surgery is now available for enhancing the quality of clinical practice and facilitating comparisons across different ERAS programs.

Keywords: core outcome set; enhanced recovery after surgery; heart valve surgery; interprofessional; minimally invasive cardiac surgery.

Graphical abstract

Figure 1:

PRISMA flow diagram (adapted from Page et al. 2021).

Figure 2:

Final core outcome set for ERAS programs in minimally invasive cardiac surgery.