Panamerican Journal of Trauma, Critical Care & Emergency Surgery

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VOLUME 12 , ISSUE 1 ( January-April, 2023 ) > List of Articles


Using the Delphi Method to Establish a Novel and Universal System for Classifying Indications behind Delayed Abdominal Closure

Sachin Doshi, Khushali Shrenik Parikh, Christine Nguyen, David Gomez, Joao B Rezende-Neto

Keywords : Abdomen, Abdominal injury, Abdominal trauma, Blunt abdominal trauma, Damage control, Damage control surgery, Emergency general surgery, Emergency surgery, Open abdomen, Open abdominal

Citation Information : Doshi S, Parikh KS, Nguyen C, Gomez D, Rezende-Neto JB. Using the Delphi Method to Establish a Novel and Universal System for Classifying Indications behind Delayed Abdominal Closure. Panam J Trauma Crit Care Emerg Surg 2023; 12 (1):47-55.

DOI: 10.5005/jp-journals-10030-1402

License: CC BY-NC 4.0

Published Online: 29-04-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Introduction: Delayed fascial closure is a common lifesaving feature of damage control laparotomy but may result in serious complications. Accordingly, it should only be applied when required; however, a paucity of guidelines and framework for research makes knowing when this is challenging. This study aims to evaluate a classification system that facilitates the categorization of clinical reasoning behind delayed fascial closure. Methods: A literature search on open abdomens in trauma or acute care surgery over 5 years (n = 185) were simplified into 11 unique scenarios. The Delphi method was employed to capture expert opinions from 202 clinical experts internationally. Participants classified each scenario into one or more of three categories—anatomic, physiologic, and/or logistic reason to leave the abdomen open. This is based on a classification system previously proposed by our group. Three rounds of the survey were distributed, with supplemental information provided between rounds, as per the Delphi process. Results: In the first round, 600 international surgeons and intensivists were approached with 168 responses. In round 2, 24 of 55 traumatologists responded, and in round 3, 10 of 30 trauma surgeons responded. At the end of round 3, a strong consensus for appropriate classification (≥95%) was achieved for scenarios 1 and 2, consensus approval (≥75–94%) for scenarios 3, 6, and 10, and majority approval (≥50–74%) for the remaining scenarios. Conclusion: This study demonstrates the universality of a classification system for delayed fascial closure in damage control surgery. The previous absence of such a system has been a barrier in the effective study of delayed abdominal closure, given that indications can be widely disparate for the same procedure. Laying this foundation will allow trauma researchers to better understand delayed abdominal closure and ensure its optimized application or lack thereof.

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