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

Int J Surg. 2020 Jul:79:309-316. doi: 10.1016/j.ijsu.2020.06.015. Epub 2020 Jun 9.


Background: International 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.

Methods: Delphi 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.

Results: The 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.

Conclusion: Initial 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.

Keywords: COVID-19; Delphi consensus; Guidance; Surgery.

MeSH terms

  • Australia / epidemiology
  • Betacoronavirus
  • COVID-19
  • Consensus*
  • Coronavirus Infections / epidemiology*
  • Cross-Sectional Studies
  • Delphi Technique
  • Europe / epidemiology
  • Humans
  • Pandemics*
  • Pneumonia, Viral / epidemiology*
  • Practice Guidelines as Topic*
  • SARS-CoV-2
  • Surgical Procedures, Operative*
  • United Kingdom / epidemiology
  • United States / epidemiology