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

TitleAn International Expert Delphi Consensus on Defining Textbook Outcome in Liver Surgery (TOLS)
Authors
Keywordscomposite measure
laparoscopic liver surgery
liver surgery
minimally invasive liver surgery
patient outcome
quality of care
robotic liver surgery
textbook outcome
Issue Date1-May-2023
PublisherLippincott, Williams & Wilkins
Citation
Annals of Surgery, 2023, v. 277, n. 5, p. 821-828 How to Cite?
Abstract

Objective: 

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.

Background: 

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.

Methods: 

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.

Results: 

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.

Conclusions: 

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.


Persistent Identifierhttp://hdl.handle.net/10722/339426
ISSN
2023 Impact Factor: 7.5
2023 SCImago Journal Rankings: 2.729
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorGörgec, Burak-
dc.contributor.authorBenedetti, Cacciaguerra Andrea-
dc.contributor.authorPawlik, Timothy M-
dc.contributor.authorAldrighetti, Luca A-
dc.contributor.authorAlseidi, Adnan A-
dc.contributor.authorCillo, Umberto-
dc.contributor.authorKokudo, Norihiro-
dc.contributor.authorGeller, David A-
dc.contributor.authorWakabayashi, Go-
dc.contributor.authorAsbun, Horacio J-
dc.contributor.authorBesselink, Marc G-
dc.contributor.authorCherqui, Daniel-
dc.contributor.authorCheung, Tan To-
dc.contributor.authorClavien, Pierre-Alain-
dc.contributor.authorConrad, Claudius-
dc.contributor.authorD’Hondt, Mathieu-
dc.contributor.authorDagher, Ibrahim-
dc.contributor.authorDervenis, Christos-
dc.contributor.authorDevar, John-
dc.contributor.authorDixon, Elijah-
dc.contributor.authorEdwin, Bjørn-
dc.contributor.authorEfanov, Mikhail-
dc.contributor.authorEttore, Giuseppe M-
dc.contributor.authorFerrero, Alessandro-
dc.contributor.authorFondevilla, Constantino-
dc.contributor.authorFuks, David-
dc.contributor.authorGiuliante, Felice-
dc.contributor.authorHan, Ho-Seong-
dc.contributor.authorHonda, Goro-
dc.contributor.authorImventarza, Oscar-
dc.contributor.authorKooby, David A-
dc.contributor.authorLodge, Peter-
dc.contributor.authorLopez-Ben, Santiago-
dc.contributor.authorMachado, Marcel A-
dc.contributor.authorMarques, Hugo P-
dc.contributor.authorO’Rourke, Nick-
dc.contributor.authorPekolj, Juan-
dc.contributor.authorPinna, Antonio D-
dc.contributor.authorPortolani, Nazario-
dc.contributor.authorPrimrose, John-
dc.contributor.authorRotellar, Fernando-
dc.contributor.authorRuzzenente, Andrea-
dc.contributor.authorSchadde, Erik-
dc.contributor.authorSiriwardena, Ajith K-
dc.contributor.authorSmadi, Sameer-
dc.contributor.authorSoubrane, Olivier-
dc.contributor.authorTanabe, Kenneth K-
dc.contributor.authorTeh, Catherine SC-
dc.contributor.authorTorzilli, Guido-
dc.contributor.authorVan Gulik, Thomas M-
dc.contributor.authorVivarelli, Marco-
dc.contributor.authorWigmore, Stephen J-
dc.contributor.authorAbu, Hilal Mohammad -
dc.date.accessioned2024-03-11T10:36:31Z-
dc.date.available2024-03-11T10:36:31Z-
dc.date.issued2023-05-01-
dc.identifier.citationAnnals of Surgery, 2023, v. 277, n. 5, p. 821-828-
dc.identifier.issn0003-4932-
dc.identifier.urihttp://hdl.handle.net/10722/339426-
dc.description.abstract<h3>Objective: </h3><p>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.</p><h3>Background: </h3><p>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.</p><h3>Methods: </h3><p>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.</p><h3>Results: </h3><p>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.</p><h3>Conclusions: </h3><p>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.</p>-
dc.languageeng-
dc.publisherLippincott, Williams & Wilkins-
dc.relation.ispartofAnnals of Surgery-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subjectcomposite measure-
dc.subjectlaparoscopic liver surgery-
dc.subjectliver surgery-
dc.subjectminimally invasive liver surgery-
dc.subjectpatient outcome-
dc.subjectquality of care-
dc.subjectrobotic liver surgery-
dc.subjecttextbook outcome-
dc.titleAn International Expert Delphi Consensus on Defining Textbook Outcome in Liver Surgery (TOLS)-
dc.typeArticle-
dc.identifier.doi10.1097/SLA.0000000000005668-
dc.identifier.scopuseid_2-s2.0-85141300072-
dc.identifier.volume277-
dc.identifier.issue5-
dc.identifier.spage821-
dc.identifier.epage828-
dc.identifier.eissn1528-1140-
dc.identifier.isiWOS:000989182800016-
dc.identifier.issnl0003-4932-

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