This modified Delphi study provides an expert-informed consensus framework supporting symptom-guided surgical timing, physiologic stability, counseling, and structured follow-up for adults with recent concussion undergoing noncardiac extracranial surgery.
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Supports deferring elective surgery until concussion symptoms resolve; extends expert consensus to perioperative management and warrants prospective validation.
Many patients present for surgery soon after concussion, when cerebral physiologic regulation may remain disturbed, and no evidence-based guideline or standardized consensus recommendations exist. We sought expert consensus for adults with recent concussion undergoing noncardiac extracranial surgery. We conducted a two-round modified Delphi study (November 2025-March 2026). Round 1 items, drafted from a systematic literature search, included case vignettes. Experts identified by bibliographic screening, directories, and nomination rated items on a five-point Likert scale; "do not know" responses were excluded from the denominator. Consensus was defined a priori as 75% agreement or greater, and strong consensus as 85% or greater. Thirty-five experts (33 anesthesiologists) from 17 countries completed both rounds; 13 of 16 Round 2 statements reached consensus. Agreement was unanimous for preoperative screening for concussion symptoms and neurologic red flags, and for avoidance of hypoxemia, abnormal carbon dioxide tension, sustained hypotension, and marked hypertension. Strong consensus supported generally deferring elective surgery until concussion symptoms resolve (97%), preoperative counseling (97%), structured follow-up (94%), and extended postoperative monitoring in higher-risk patients (91%). Consensus was not reached for regional anesthesia or monitored anesthesia care over general anesthesia (74%), electroencephalography-based depth of anesthesia monitoring (73%), or cautious long-acting neuraxial opioid use (69%). The panel did not define symptom resolution and established no symptom-independent waiting interval or concussion-specific numeric physiologic threshold. This anesthesiology-led consensus supports symptom-guided timing, physiologic stability, counseling, and structured follow-up; anesthetic technique, electroencephalographic monitoring, and neuraxial opioid use remain unresolved. The statements form an expert-informed framework, not an evidence-based practice guideline.
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Elganga et al. (2026) studied Adults with recent concussion undergoing noncardiac extracranial surgery (n=35). Perioperative management consensus statements (two-round modified Delphi process) was evaluated on Expert consensus (defined a priori as >=75% agreement, strong consensus as >=85% agreement) on Round 2 perioperative management statements. A modified Delphi panel reached consensus on 13 of 16 statements, strongly supporting deferring elective surgery until concussion symptoms resolve and unanimous physiologic stability.
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