Abstract
To develop a COS, an agreed minimum set of outcomes to measure and report in all studies evaluating the introduction and evaluation of novel surgical techniques. Agreement on the key outcomes to measure and report for safe and efficient surgical innovation is lacking, hindering transparency and risking patient harm. (I) Generation of a list of outcome domains from published innovation-specific literature, policy/regulatory body documents, and surgeon interviews; (II) Prioritization of identified outcome domains using an international, multi-stakeholder Delphi survey; (III) Consensus meeting to agree the final COS. Participants were international stakeholders, including patients/public, surgeons, device manufacturers, regulators, trialists, methodologists, and journal editors. A total of 7972 verbatim outcomes were identified, categorized into 32 domains, and formatted into survey items/questions. Four hundred ten international participants (220 professionals, 190 patients/public) completed at least one round 1 survey item, of which 153 (69.5%) professionals and 116 (61.1%) patients completed at least one round 2 item. Twelve outcomes were scored "consensus in" ("very important" by ≥70% of patients and professionals) and 20 "no consensus." A consensus meeting, involvingcontext: modifications, unexpected disadvantages, device problems, technical procedure completion success, patients' experience relating to the procedure being innovative, surgeons'/operators' experience. Other domains relate to intended benefits, whether the overall desired effect was achieved and expected disadvantages. The COS is recommended for use in all studies before definitive randomized controlled trial evaluation to promote safe, transparent, and efficient surgical innovation.
Highlights
Surgical innovation is essential to improving patient care[1]
The core outcome set (COS) was developed in the Core Outcomes for early pHasE Surgical Innovation and deVicEs (COHESIVE) study, using consensus-based methods and in accordance with the principles outlined in the Core Outcome Measures for Effectiveness Trials (COMET) Handbook[11] and Core Outcome Set-STAndards for Development (COS-STAD) guidelines[12]
Following de-duplication and categorization, 32 outcome domains were included in the long list/conceptual framework
Summary
Surgical innovation is essential to improving patient care[1]. Optimal innovation is undertaken safely and transparently[2]. One challenge to safe and transparent innovation is consistency and transparency in the selection and reporting of relevant key outcomes. The IDEAL (Idea, Development, Exploration, Assessment, Long-term follow-up) framework describes the characteristics and recommended study designs for the stages of innovation through which new surgical procedures typically pass, describing broad outcome domains that may be measured at each stage[3]. Recently-published IDEAL reporting guidelines have further emphasised the need for transparent reporting of appropriate technical, clinical and patient-reported outcomes, harms and unintended effects[4]. Consensus on which specific outcomes are essential to measure at each stage has not yet been reached, and requires a rigorous, evidencebased approach
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