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\'.
CONCLUSIONS: 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.
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\'.
CONCLUSIONS: 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.
摘要：
背景：教科书结局是综合结局指标，反映了患者理想的总体体验。在择期手术文献中有许多这些文献，但没有针对紧急剖腹手术后的患者提出教科书结果。目的是在专家和患者之间达成国际共识，以获得非创伤和创伤急诊剖腹手术的最佳教科书成果。
方法：进行了修改的Delphi练习，计划进行三轮，以就基于类别的最佳教科书成果达成共识，单个结局指标的数量和重要性(李克特量表1-5)。非创伤和创伤有不同的问题。在第2轮之后进行了患者参与练习，以告知最后一轮。
结果：共有来自53个国家的337名参与者参加了所有三轮演习。最终的教科书成果分为“早期”和“长期”。对于非外伤患者，建议的早期教科书结果已出院，无严重术后并发症（Clavien-Dindo≥III级；包括腹腔内败血症，器官衰竭,计划外的再次手术或死亡)。对于外伤患者，在止血后没有意外输血就出院了，并且没有严重的术后并发症（适用于创伤≥III级的Clavien-Dindo；包括腹腔内败血症，器官衰竭,计划外的重新手术或死亡)。非创伤和创伤的长期教科书成果是实现早期教科书成果，并在1年时恢复基线生活质量。
结论：非创伤和创伤紧急剖腹手术的专家达成了国际共识。这些现在需要对患者数据进行临床验证。
方法：进行了修改的Delphi练习，计划进行三轮，以就基于类别的最佳教科书成果达成共识，单个结局指标的数量和重要性(李克特量表1-5)。非创伤和创伤有不同的问题。在第2轮之后进行了患者参与练习，以告知最后一轮。
结果：共有来自53个国家的337名参与者参加了所有三轮演习。最终的教科书成果分为“早期”和“长期”。对于非外伤患者，建议的早期教科书结果已出院，无严重术后并发症（Clavien-Dindo≥III级；包括腹腔内败血症，器官衰竭,计划外的再次手术或死亡)。对于外伤患者，在止血后没有意外输血就出院了，并且没有严重的术后并发症（适用于创伤≥III级的Clavien-Dindo；包括腹腔内败血症，器官衰竭,计划外的重新手术或死亡)。非创伤和创伤的长期教科书成果是实现早期教科书成果，并在1年时恢复基线生活质量。
结论：非创伤和创伤紧急剖腹手术的专家达成了国际共识。这些现在需要对患者数据进行临床验证。
