373 Scoping Review: Definition of Major Abdominal Surgery

Abstract

Abstract Aim The aim of this scoping review was to propose a definition major abdominal surgery (MAS). Method We searched the following databases: Medline, EMBASE, Web of Science, Global Health, Health Management Information Consortium, APA PsycInfo. Original research articles, systematic reviews or meta-analyses published between 1980 and 26 April 2022 were included in this scoping review. Inclusion criteria consisted of: specific reference to the operation, adult population, treatment within secondary care, and availability of full text. Three authors assessed each article’s eligibility for inclusion. Results 5,663 articles were identified in our search, of which 767 underwent full-text review and 312 were included in the scoping review. Half of the included articles were observational trials (54.5%) and one third were randomised control trials (37.8%). A significant proportion of studies were conducted in Europe (47.4%) or North America (19.2%), with a minority of studies conducted in the UK (4.5%). Just under half of these studies were led by anaesthetists (47.4%) rather than surgeons with 45.8% of studies focused on post-operative care and outcomes. Analysis of these studies revealed that the description of major abdominal surgery fell into 4 broad categories: anatomical criteria, procedure-based criteria, specialty-specific resections, and arbitrary procedures. Conclusions We established that there is no agreed definition of major abdominal surgery. We propose that any definition of major abdominal surgery should be based on anatomical criteria alone. Research is underway to confirm a difference in the post-operative recovery profiles of patients undergoing MAS and non-MAS procedures as per our classification.