• Ara A Vaporciyan, Vid Fikfak, Matthew C Lineberry, Yoon Soo Park, and Ara Tekian.
• Department of Thoracic and Cardiovascular Surgery, Division of Surgery, MD Anderson Cancer Center, University of Texas, Houston, Texas. Electronic address: avaporci@mdanderson.org.
• Ann. Thorac. Surg. 2017 Dec 1; 104 (6): 2087-2092.

BackgroundSurgical skill assessment tools frequently reflect the opinions of small groups of surgeons. That raises concerns over their generalizability as well as their utilization when applied broadly. A Delphi approach could engage a broad group of experts to identify key elements for a checklist assessing coronary anastomotic skill, improving generalizability.MethodsExpert surgeons in North America (10 or more years in practice, actively teaching coronary artery surgery) were contacted randomly to participate. Consenting surgeons first provided items they believed were mandatory when performing a coronary artery bypass. These were then entered into a three-round Delphi. Positive consensus was reached when 75% or more of participants ranked an item mandatory.ResultsSixteen faculty consented to participate. Each participant provided 25 ± 10 items. The 407 items provided were condensed, resulting in 146 items in the final list, divided into six sections based on the conduct of the operation. Twenty-three items reached consensus in the first round, 14 in the second, and 3 in the third. These 40 items represented only 27% of the initial 146 items. Agreement within sections varied widely, from 0% for "management of assistants" to 47% for "testing and final steps."ConclusionsA randomly selected group of experts using a Delphi approach can generate a checklist to assess construction of a coronary artery bypass. Considerable disagreement among experts regarding what steps are mandatory calls into question the generalizability of any locally developed checklist.Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

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