Details

Autor(en) / Beteiligte

• Görgec, Burak
• Benedetti Cacciaguerra, Andrea
• Pawlik, Timothy M
• Aldrighetti, Luca A
• Alseidi, Adnan A
• Cillo, Umberto
• Kokudo, Norihiro
• Geller, David A
• Wakabayashi, Go
• Asbun, Horacio J
• Besselink, Marc G
• Cherqui, Daniel
• Cheung, Tan To
• Clavien, Pierre-Alain
• Conrad, Claudius
• D'Hondt, Mathieu
• Dagher, Ibrahim
• Dervenis, Christos
• Devar, John
• Dixon, Elijah
• Edwin, Bjørn
• Efanov, Mikhail
• Ettore, Giuseppe M
• Ferrero, Alessandro
• Fondevilla, Constantino
• Fuks, David
• Giuliante, Felice
• Han, Ho-Seong
• Honda, Goro
• Imventarza, Oscar
• Kooby, David A
• Lodge, Peter
• Lopez-Ben, Santiago
• Machado, Marcel A
• Marques, Hugo P
• O'Rourke, Nick
• Pekolj, Juan
• Pinna, Antonio D
• Portolani, Nazario
• Primrose, John
• Rotellar, Fernando
• Ruzzenente, Andrea
• Schadde, Erik
• Siriwardena, Ajith K
• Smadi, Sameer
• Soubrane, Olivier
• Tanabe, Kenneth K
• Teh, Catherine S C
• Torzilli, Guido
• Van Gulik, Thomas M
• Vivarelli, Marco
• Wigmore, Stephen J
• Abu Hilal, Mohammad

Titel

An International Expert Delphi Consensus on Defining Textbook Outcome in Liver Surgery (TOLS)

Ist Teil von

• Annals of surgery, 2023-05, Vol.277 (5), p.821-828

Ort / Verlag

United States

Erscheinungsjahr

2023

Quelle

MEDLINE

Beschreibungen/Notizen

• To reach global expert consensus on the definition of TOLS in minimally invasive and open liver resection among renowned international expert liver surgeons using a modified Delphi method. Textbook outcome is a novel composite measure combining the most desirable postoperative outcomes into one single measure and representing the ideal postoperative course. Despite a recently developed international definition of Textbook Outcome in Liver Surgery (TOLS), a standardized and expert consensus-based definition is lacking. This international, consensus-based, qualitative study used a Delphi process to achieve consensus on the definition of TOLS. The survey comprised 6 surgical domains with a total of 26 questions on individual surgical outcome variables. The process included 4 rounds of online questionnaires. Consensus was achieved when a threshold of at least 80% agreement was reached. The results from the Delphi rounds were used to establish an international definition of TOLS. In total, 44 expert liver surgeons from 22 countries and all 3 major international hepato-pancreato-biliary associations completed round 1. Forty-two (96%), 41 (98%), and 41 (98%) of the experts participated in round 2, 3, and 4, respectively. The TOLS definition derived from the consensus process included the absence of intraoperative grade ≥2 incidents, postoperative bile leakage grade B/C, postoperative liver failure grade B/C, 90-day major postoperative complications, 90-day readmission due to surgery-related major complications, 90-day/in-hospital mortality, and the presence of R0 resection margin. This is the first study providing an international expert consensus-based definition of TOLS for minimally invasive and open liver resections by the use of a formal Delphi consensus approach. TOLS may be useful in assessing patient-level hospital performance and carrying out international comparisons between centers with different clinical practices to further improve patient outcomes.