International Delphi Expert Consensus on Safe Return to Surgical and Endoscopic Practice: From the Coronavirus Global Surgical Collaborative

Horacio J. Asbun, Mohammad Abu Hilal, Filipe Kunzler, Domenech Asbun, Jaap Bonjer, Kevin Conlon, Nicolas Demartines, Liane S. Feldman, Salvador Morales-Conde, Andrea Pietrabissa, Aurora D. Pryor, Christopher M. Schlachta, Patricia Sylla, Eduardo M. Targarona, Yolanda Agra, Marc G. Besselink, Mark Callery, Sean P. Cleary, Luis De La Cruz, Philippe EckertChad Evans, Ho Seong Han, Daniel B. Jones, Tong Joo Gan, Daniel Koch, Keith D. Lillemoe, Davide Lomanto, Jeffrey Marks, Brent Matthews, John Mellinger, William Scott Melvin, Eduardo Moreno-Paquentin, Claudio Navarrete, Timothy M. Pawlik, Patrick Pessaux, Walter Ricciardi, Steven Schwaitzberg, Paresh Shah, Joseph Szokol, Mark Talamini, Ricardo Torres, Alessandro Triboldi, Suthep Udomsawaengsup, Federica Valsecchi, Jean Nicolas Vauthey, Michael Wallace, Steven D. Wexner, Michael Zinner, Nader Francis

Research output: Contribution to journalArticlepeer-review


Objective:The aim of this work is to formulate recommendations based on global expert consensus to guide the surgical community on the safe resumption of surgical and endoscopic activities.Background:The COVID-19 pandemic has caused marked disruptions in the delivery of surgical care worldwide. A thoughtful, structured approach to resuming surgical services is necessary as the impact of COVID-19 becomes better controlled. The Coronavirus Global Surgical Collaborative sought to formulate, through rigorous scientific methodology, consensus-based recommendations in collaboration with a multidisciplinary group of international experts and policymakers.Methods:Recommendations were developed following a Delphi process. Domain topics were formulated and subsequently subdivided into questions pertinent to different aspects of surgical care in the COVID-19 crisis. Forty-four experts from 15 countries across 4 continents drafted statements based on the specific questions. Anonymous Delphi voting on the statements was performed in 2 rounds, as well as in a telepresence meeting.Results:One hundred statements were formulated across 10 domains. The statements addressed terminology, impact on procedural services, patient/staff safety, managing a backlog of surgeries, methods to restart and sustain surgical services, education, and research. Eighty-three of the statements were approved during the first round of Delphi voting, and 11 during the second round. A final telepresence meeting and discussion yielded acceptance of 5 other statements.Conclusions:The Delphi process resulted in 99 recommendations. These consensus statements provide expert guidance, based on scientific methodology, for the safe resumption of surgical activities during the COVID-19 pandemic.

Original languageEnglish (US)
Pages (from-to)50-56
Number of pages7
JournalAnnals of surgery
Issue number1
StatePublished - Jul 1 2021


  • Delphi
  • backlog
  • consensus
  • coronavirus
  • endoscopy
  • pandemic
  • pathways
  • recommendations
  • resources
  • resumption
  • surgery

ASJC Scopus subject areas

  • Surgery


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