Textbook outcomes in DIEP flap breast reconstruction: a Delphi study to establish consensus.
Ronnie L Shammas, Geoffroy C Sisk, Christopher J Coroneos, Anaeze C Offodile, Rene D Largo, Arash Momeni, Nicholas L Berlin, Summer E Hanson, Adeyiza O Momoh, Jonas A Nelson, Evan Matros, Kristen Rezak, Brett T Phillips
Author Information
Ronnie L Shammas: Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, USA. ORCID
Geoffroy C Sisk: Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, USA.
Christopher J Coroneos: Division of Plastic Surgery, Department of Surgery, Hamilton, ON, Canada.
Anaeze C Offodile: Department of Plastic and Reconstructive Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Rene D Largo: Department of Plastic and Reconstructive Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Arash Momeni: Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, Ca, USA.
Nicholas L Berlin: Department of Surgery, Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA.
Summer E Hanson: Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA.
Adeyiza O Momoh: Department of Surgery, Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA.
Jonas A Nelson: Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Evan Matros: Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Kristen Rezak: Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, USA.
Brett T Phillips: Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, USA. brett.phillips@duke.edu.
PURPOSE: Composite measures, like textbook outcomes, may be superior to individual metrics when assessing hospital performance and quality of care. This study utilized a Delphi process to define a textbook outcome in DIEP flap breast reconstruction. METHODS: A two-round Delphi survey defined: (1) A textbook outcome, (2) Exclusion criteria for a study population, and (3) Respondent opinion regarding textbook outcomes. An a priori threshold of���������70% agreement among respondents established consensus among the tested statements. RESULTS: Out of 85 invitees, 48 responded in the first round and 41 in the second. A textbook outcome was defined as one that meets the following within 90 days: (1) No intraoperative complications, (2) Operative duration���������12 h for bilateral and���������10 h for unilateral/stacked reconstruction, (3) No post-surgical complications requiring re-operation, (4) No surgical site infection requiring IV antibiotics, (5) No readmission, (6) No mortality, (7) No systemic complications, and (8) Length of stay���<���5 days. Exclusion criteria for medical and surgical characteristics (e.g., BMI���>���40, HgbA1c���>���7) and case-volume cut-offs for providers (������21) and institutions (������44) were defined. Most agreed that textbook outcomes should be defined for complex plastic surgery procedures (75%) and utilized to gauge hospital performance for microsurgical breast reconstruction (77%). CONCLUSION: This Delphi study identified (1) Key elements of a textbook outcome for DIEP flap breast reconstruction, (2) Exclusion criteria for future studies, and (3) Characterized surgeon opinions regarding the utility of textbook outcomes in serving as quality metric for breast reconstruction care.
