A Delphi process to define medical reporting outcomes for urgent surgical pathways

Abstract

Background: As the demand for high-quality healthcare grows, there is a pressing need for comprehensive methods to assess the quality of hospital care. Lack of standardization makes it difficult to compare urgent surgical outcomes across studies. Our group used a modified Delphi methodology to define the outcomes that should be reported or compared when evaluating urgent surgical care.

Methods: This three-round Delphi process took place from May to October 2024. It was conducted with an international panel of medico-surgical experts from 16 countries. We aimed to select, based on a 2-level consensus assessment, reporting outcomes for urgent surgical pathways.

Results: Initially, 87 items were classified under 8 headings. 26 outcomes were selected after the second Delphi round. A third round was required to validate 3 additional outcomes. Among the selected outcomes were in-hospital or 30-day mortality, 15 items addressing perioperative morbidity, as well as factors related to the patient journey: preoperative (surgical waiting time), intraoperative (surgical bleeding), and postoperative aspects (9 items selected). Notably, no items from the 'patient satisfaction' and 'medico-economics' headings were retained. Panelists deemed it essential to use multi-criteria outcomes (i.e., combining items from the 8 headings) to evaluate urgent surgical care pathways.

Conclusions: A set of 29 relevant outcomes will help to develop a more comprehensive approach for urgent surgical care evaluation. It enables the development of new prioritization policies and a better study of outcomes for urgent surgeries. It is worth noting the lack of economic criteria and patient satisfaction measures.

Keywords: Delphi methodology; Pathway optimization; Prioritization evaluation; Surgical outcome; Surgical pathways; Urgent surgery.