International Delphi Expert Consensus on Safe Return to Surgical and Endoscopic Practice

From the Coronavirus Global Surgical Collaborative

Horacio J. Asbun, MD, FACS; Mohammad Abu Hilal, MD, PhD, FACS, FRCS; Filipe Kunzler, MD; Domenech Asbun, MD; Jaap Bonjer, MD, PhD, MBA, FRCSC; Kevin Conlon, MD, FRCSI, FACS, FRCSG, FTCD; Nicolas Demartines, MD, FACS, FRCS; Liane S. Feldman, MDCM, FACS, FRCS; Salvador Morales-Conde, MD, PhD; Andrea Pietrabissa, MD, FACS; Aurora D. Pryor, MD, FACS; Christopher M. Schlachta, BSc, MDCM, FRCSC, FACS; Patricia Sylla, MD, FACS, FASCRS; Eduardo M. Targarona, MD, PhD, FACS; Yolanda Agra, MD, PHD, MHRs; Marc G. Besselink, MD, Msc, PhD; Mark Callery, MD, FACS; Sean P. Cleary, MD, FACS; Luis De La Cruz, MD; Philippe Eckert, MD; Chad Evans, BA; Ho-Seong Han, MD, MS, (Gen Surg), PhD; Daniel B. Jones, MD, MS, FASMBS; Tong Joo Gan, MD, MHS, FRCA, MBA; Daniel Koch, MD; Keith D. Lillemoe, MD, FACS; Davide Lomanto, MD, PhD, FAMS; Jeffrey Marks, MD, FACS; Brent Matthews, MD, FACS; John Mellinger, MD, FACS; William Scott Melvin, MD, FACS; Eduardo Moreno-Paquentin, MD, FACS; Claudio Navarrete, MD; Timothy M. Pawlik, MD, PhD, MPH; Patrick Pessaux, MD, PhD; Walter Ricciardi, MD, MPH, MSc; Steven Schwaitzberg, MD, FACS; Paresh Shah, MD, FACS; Joseph Szokol, MD; Mark Talamini, MD, FACS; Ricardo Torres, MD; Alessandro Triboldi; Suthep Udomsawaengsup, MD, FRCST, FACS; Federica Valsecchi, PhD; Jean-Nicolas Vauthey, MD, FACS; Michael Wallace, MD; Steven D. Wexner, MD, PhD, FACS, FRCS, FRCS; Michael Zinner, MD, FACS; Nader Francis, MBChB, FRCS, PhD


Annals of Surgery. 2021;274(1):50-56. 

In This Article


A total of 10 domains pertinent to surgery and endoscopy during the global crisis were identified, and 12 general questions were jointly created by the Executive and Steering Committees within these domains. The questions pertaining to each domain were addressed by the 10 groups of experts in the form of 100 statements (Figure 1).

Figure 1.

Flowchart of the Delphi process. Numbers between boxes reflect the number of statements carried on to be voted on the next stage. The Expert Group includes members of the Steering Committee but excludes members of the Executive Committee.

Eighty-three of the statements (83.0%) were approved during D1. Fifteen statements that were not approved were revised and submitted for voting in D2. Two statements that did not reach consensus were considered by the author subgroup to not warrant revision. A total of 440 comments were made during D1.

Eleven out of the 15 submitted statements (73.3%) were approved in D2. There were 74 comments submitted in D2. The large majority of the revised statements attained a significantly improved approval score after revision.

Twenty-nine experts attended VM3. Four unapproved statements from D2 were discussed and voted on. Further discussion was held about various other topics for better clarification and standardization. This process included revisiting one of the previously discarded statements from D1. This statement was also revised and submitted for voting. After detailed discussion and revision, all five statements voted on in VM3 were approved.

Overall, the Delphi process approved 99 statements (99.0%) for the expert consensus. The questions, final recommendations, and respective approval rates in each step of the Delphi processes (D1/D2/VM3) are depicted in supplemental table 1, Flowcharts for prompt visualization of the statements pertinent to patients and staff are depicted in Figures 2 and 3.

Figure 2.

Flowchart for patient tracking, in-hospital screening, and preoperative testing (statement reference number in parenthesis).

Figure 3.

Flowchart and safety measures for staff in the perioperative setting (statement reference number in parenthesis).