key: cord-0699926-o9hubtft
authors: Allan, Morven; Mahawar, Kamal; Blackwell, Sue; Catena, Fausto; Chand, Manish; Dames, Nicola; Goel, Ramen; Graham, Yitka N H; Kothari, Shanu N; Laidlaw, Lynn; Mayol, Julio; Moug, Susan; Petersen, Rebecca P; Pryor, Aurora D; Smart, Neil J; Taylor, Mark; Toogood, Giles J; Wexner, Steven D; Zevin, Boris; Wilson, Michael S J
title: COVID-19 research priorities in surgery (PRODUCE study): A modified Delphi process
date: 2020-09-01
journal: Br J Surg
DOI: 10.1002/bjs.12015
sha: 404c04abec99193b860152c821a8426bd55e9148
doc_id: 699926
cord_uid: o9hubtft

nan

Phase I: Participants were invited by twitter to submit questions across the spectrum of "Surgery in the COVID-19 pandemic" via surveymonkey. Members of endorsing societies were also invited via email. Questions were, reviewed, amended and categorized. Phase II: Participants prioritised Phase 1 questions on a Likert Scale (5 -highest research priority). The survey remained open for 72 hours, with the question order randomly assigned. Results were reviewed by a blinded steering committee and questions scoring a weighted mean ≥ 3⋅8 were included in phase III. Phase III: Participants performed a final round of prioritization over a further 72-hour period. Results were reviewed in the same manner as phase II. The criteria for inclusion in the final list of prioritised research questions was a mean score of ≥4⋅0, a score of 1 or 2 by <10%, and 4 or 5 by >70% of respondents.

A total of 510 research questions were submitted by 130 participants during Phase I with a median of 4 questions (range 1-10). Submissions were from predominantly general surgeons but included clinical scientists, patients, and other medical specialties from 25 countries (Fig. 1a) . Following review by the steering committee, 96 questions were progressed for prioritisation in phase II.

Two-hundred and thirteen participants prioritised the questions

*Surgeons (other): Trauma and Orthopaedics, Paediatric, Plastic, Urology, Obstetrics and gynaecology.

in phase II, with a 90⋅6% completion rate. These were predominantly general surgeons from 34 countries (Fig. 1b) . Thirty-nine questions were progressed for prioristisation in round III. Questions were prioritized by 216 stakeholders from 26 countries, with a 90⋅3% completion rate in phase III (Fig. 1c) . At the end of phase III, 13 questions met the criteria to be defined as a high research priority ( Table 1) . Thirty-eight participated in at least two of the three phases throughout the Delphi process.

The COVID-19 pandemic has had a significant impact on global surgical activity which will persist for an unknown period of time 4 . There was some repetition in the 13 final questions such that further research could be condensed down to five key areas: virus aerosolization during surgery; effective personal protective equipment (PPE); pre-operative screening; antibodies/immunity; viral infection and surgical outcomes. A safe strategy to facilitate surgery is fundamental to the patient and staff safety 5, 6 . There are limitations to the results presented here including that countries with high response rates were those nations in which the surgical societies supported the study. Lower response rates were noted from certain countries where the virus first emerged.

Morven Allan 1 , Kamal Mahawar 2,3 , Sue Blackwell 4 , Fausto Catena 5 , Manish Chand 6 , Nicola Dames 7 , Ramen Goel 8 , Yitka NH Graham 9 , Shanu N Kothari 10 , Lynn Laidlaw 11 ,

COVID-19) Situation Report -121. WHO: Geneva

A modified Delphi process to establish future research priorities in malignant oesophagogastric surgery

Use of a modified Delphi approach to develop research priorities in HPB surgery across the United Kingdom

Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans

Surgery during the COVID-19 pandemic: operating room suggestions from an international Delphi process