The study was carried out as a three-round Delphi process. The focus of the study was to identify and categorize preoperative risk factors for PPC. The Delphi process was carried out at Aarhus University Hospital in Denmark between September 2014 and June 2015.

Potential participants were considered eligible for the Delphi panel if they; 1) had a degree in medicine, physiotherapy or nursing, 2) had a solid clinical experience within the area of thoracic or abdominal surgery, and 3) could read and understand Danish. The Delphi panel was strategically selected by the investigators to ensure representation by all specialties and health professionals within the field of interest. In total, 22 potential panelists were invited to participate in the Delphi process. Of those invited, 18 had more than 15 years of clinical experience and three had published relevant research.

The Central Denmark Region Committee on Health Research Ethics was notified about the study, but further approval was not considered necessary. The panelists were informed about the Delphi process and that anonymity was ensured.

Prior to the Delphi process, the literature was reviewed to identify preoperative risk factors for PPC related to thoracic and abdominal surgery. A total of 21 risk factors were identified and included as a starting point for the first Delphi round. To obtain a common understanding of PPC, the panelists were introduced to The Melbourne Group Scale (MGS-2) [13]. As seen in Figure 1, the MGS-2 is designed to detect PPC amendable to physiotherapy interventions [13], which is the focus of this study. To increase the transparency of the Delphi process, the primary investigator made a written summary of the data analysis containing both quantitative results and qualitative responses on every risk factor. This summary was sent to the panelists as feedback allowing them to reassess their initial input when making recommendations in subsequent rounds.

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Regards
ALEX JOHN
Managing Editor
General Surgery: Open Access