International Consensus About Which Major Complications Following Abdominal Aortic Aneurysm Surgery to Discuss with Patients Prior to Surgery: A Delphi Study

Abstract

Introduction - Vascular surgeons differ in the potential complications from abdominal aortic aneurysm surgery they discuss with patients prior to surgery. Typically the 'major' and the most frequently occuring complications are discussed. However, there is no uniform definition of what these 'major' complications comprise. Harmonizing the ‘major’ complications that are discussed with patients may improve the informed consent procedure and the shared decision-making process. This study aimed to reach consensus among vascular surgeons as to which complications are considered ‘major’ after surgery for an abdominal aortic aneurysm. Methods - An electronic Delphi method was used to ask vascular surgeons in Europe and North America via online questionnaires to rate specific complications as ‘major’ or ‘minor’ on a 5-point Likert scale. Consensus was reached if 80% of participants scored 1 or 2 (‘minor’ complication) or 4 or 5 (‘major’ complication). The Cochrane review of Paravastu et al.1 and reporting standards of the Society for Vascular Surgery developed by Chaikof et al.2 were used to compose lists of complications after open and endovascular abdominal aortic aneurysm surgery. Results - In the first round, 19 out of 63 invited experts participated (response rate: 30%). Participating vascular surgeons originated from a variety of countries in Europe and North-America. Vascular surgeons treating patients with abdominal aortic aneurysms reached consensus on 12 major surgical complications (Table 1). Conclusion - This e-Delphi study rendered international consensus on which complications from abdominal aortic aneurysm surgery are considered ‘major’ by vascular surgeons. Future studies should investigate whether these complications agree with the ones patients would consider as ‘major’ and would want to be informed about. Adding this knowledge may close the surgeon-patient information gap and empower vascular patients to engage in shared decision-making. Until then, this current consensus will help standardize the information discussed with patients in the consultation room.