• Int J Surg · Jul 2020

    International surgical guidance for COVID-19: Validation using an international Delphi process - Cross-sectional study.

    • Beamish Aj, Brown C, Abdelrahman T, Ryan Harper E, Harries Rl, Egan Rj, and Welsh Surgical Research Initiative (WSRI) Collaborative.
    • Swansea University Medical School, Swansea, United Kingdom; Health Education and Improvement Wales' School of Surgery, Ty Dysgu, Cefn Coed, Nantgarw, United Kingdom. Electronic address: beamishaj@gmail.com.
    • Int J Surg. 2020 Jul 1; 79: 309-316.

    BackgroundInternational professional bodies have been quick to disseminate initial guidance documents during the COVID-19 pandemic. In the absence of firm evidence, these have been developed by expert committees, limited in participant number. This study aimed to validate international COVID-19 surgical guidance using a rapid Delphi consensus exercise.MethodsDelphi statements were directly mapped to guidance from surgical professional bodies in the US and Europe (SAGES/EAES), the UK (Joint RCS), and Australasia (RACS), to validate content against international consensus. Agreement from ≥70% participants was determined as consensus agreement.ResultsThe Delphi exercise was completed by 339 individuals from 41 countries and 52 statements were mapped to the guidance, 47 (90.4%) reaching consensus agreement. Of these, 27 statements were mapped to SAGES/EAES guidance, 21 to the Joint RCS document, and 33 to the RACS document. Within the SAGES/EAES document, 92.9% of items reached consensus agreement (median 89.0%, range 60.5-99.2%), 90.4% within the Joint RCS document (87.6%, 63.4-97.9%), and 90.9% within the RACS document (85.5%, 18.7-98.8%). Statements lacking consensus related to the surgical approach (open vs. laparoscopic), dual consultant operating, separate instrument decontamination, and stoma formation rather than anastomosis.ConclusionInitial surgical COVID-19 guidance from the US, Europe and Australasia was widely supported by an international expert community, although a small number of contentious areas emerged. These findings should be addressed in future guidance iterations, and should stimulate urgent investigation of non-consensus areas.Copyright © 2020 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

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