Key result
A Delphi study of 71 domain experts reached consensus on a generic definition of postoperative complications in cardiac surgery and a 4-level classification system (Mild, Moderate, Severe, Death).
Why the study?
Postoperative complications after cardiac surgery are common, but there is a lack of consensus on what events constitute a complication and how to assess their severity.
This pilot Delphi study established expert consensus among cardiac anesthetists and critical care specialists on the definition and classification of mild and severe postoperative complications in cardiac surgery.
Answers are grounded in this paper and cite their sources.
Expert consultation on cardiac surgery complications is hypothesis-generating; leaves open validated classification for trials and practice.
BACKGROUND: Postoperative complications following cardiac surgery are common and represent a serious burden to health services and society. However, there is a lack of consensus among experts on what events should be considered as a "complication" and how to assess their severity. OBJECTIVE: This study aimed to consult domain experts to pilot the development of a definition and classification system for complications following cardiac surgery with the goal to allow the progression of standardized clinical processes and systems in cardiac surgery. METHODS: We conducted a Delphi study, which is a well-established method to reach expert consensus on complex topics. We sent 2 rounds of surveys to domain experts, including cardiac surgeons and anesthetists, to define and classify postoperative complications following cardiac surgery. The responses to open-ended questions were analyzed using a thematic analysis framework. RESULTS: In total, 71 and 37 experts' opinions were included in the analysis in Round 1 and Round 2 of the study, respectively. Cardiac anesthetists and cardiac critical care specialists took part in the study. Cardiac surgeons did not participate. Experts agreed that a classification for postoperative complications for cardiac surgery is useful, and consensus was reached for the generic definition of a postoperative complication in cardiac surgery. Consensus was also reached on classification of complications according to the following 4 levels: "Mild," "Moderate," "Severe," and "Death." Consensus was also reached on definitions for "Mild" and "Severe" categories of complications. CONCLUSIONS: Domain experts agreed on the definition and classification of complications in cardiac surgery for "Mild" and "Severe" complications. The standardization of complication identification, recording, and reporting in cardiac surgery should help the development of quality benchmarks, clinical audit, care quality assessment, resource planning, risk management, communication, and research.
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Lapp et al. (2022) studied Postoperative complications after cardiac surgery (n=71). Delphi consensus process was evaluated on Consensus on definition and classification of postoperative complications. A Delphi study of 71 domain experts reached consensus on a generic definition of postoperative complications in cardiac surgery and a 4-level classification system (Mild, Moderate, Severe, Death).
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