Textbook Outcome in Emergency General Surgery: A Scoping Review of Definitions, Clinical Applications, and Priorities for Standardization.

BACKGROUND

Textbook outcome (TO) has emerged as a composite quality metric intended to reflect an ideal perioperative course, but its role in emergency general surgery (EGS) remains unclear. This scoping review mapped how TO has been defined and applied across EGS and identified priorities for future agreement, validation, and standardization.

METHODS

The review protocol was registered in PROSPERO (CRD420261357610), and the review was conducted in accordance with PRISMA-ScR principles. MEDLINE, Embase, Web of Science, and Scopus were searched without date restriction. Eligible records included empirical clinical studies involving EGS procedures and consensus or conceptual studies directly relevant to TO in EGS. Data were charted on study characteristics, TO definitions, clinical applications, reported TO rates, determinants of TO achievement or failure, and between-study heterogeneity.

RESULTS

Five empirical studies were identified: one Delphi consensus study on emergency laparotomy and four clinical studies in cholecystectomy cohorts. One conceptual paper was retained for contextual interpretation. Clinical application evidence was concentrated in emergency cholecystectomy, whereas emergency laparotomy was represented by a consensus-based definition study without patient-level validation data. Marked heterogeneity was identified across TO definitions, particularly in complication thresholds, length-of-stay cut-offs, readmission windows, and the handling of technical success. Among clinical studies, reported TO rates ranged from 60.5% in urgent cases within a mixed cholecystectomy cohort to 86.8% in an emergency-only cohort.

CONCLUSIONS

The current EGS literature supports TO as a promising but heterogeneous composite quality concept. A single universal TO definition for all EGS procedures is unlikely to be appropriate. Future work should focus on procedure-sensitive agreement, clinical validation, and patient-centered recovery.