163 Linking surgical skills to postoperative outcomes: a Delphi study on the robot assisted radical prostatectomy The second step was a consensus group meeting with the same Dutch urologists to discuss the results of the online survey and to identify the aspects of the surgery and the perioperative events which might be associated with postoperative adverse outcomes. The steps of the Delphi process are based on protocols for consensus finding.18–21 Online two‐round Delphi Survey The results of the initial focus group were used to define seven domains in which the statements could be categorized. The domains were organized as follows: 1. The relation of the statement to postoperative complications; 2. The relation of the statement to functional results; 3. Surgical steps associated with complications (i.e. bleeding and leakage of the vesico-urethral anastomosis); 4. Surgical steps associated with postoperative erectile dysfunction; 5. Surgical steps associated with postoperative urinary incontinence; 6. Factors that play a role in the origins of postoperative complications; 7. Elements that should certainly be included in the training of novice surgeons. The statements were used to design a two-round online Delphi Survey to obtain consensus on identifying the relevant steps of the RARP procedure and their possible causal relation to postoperative complications and adverse functional outcomes. The panel members were asked to rate the relevance of each statement using a 9-point Likert scale according to the discriminatory power of each surgical step to correspond with the specified postoperative complication. A rating of 1 was defined as “extremely disagree” and a rating of 9 was defined as “extremely agree”. As described in the RAND/ UCLA Appropriateness Method22, for each item, the median agreement score, lower limit inter-percentile range (IPR), and upper limit IPR and Disagreement Index (DI) were calculated. A median agreement score of 1.0–3.0 was considered to be “disagree”, 3.1–6.9 as “uncertain”, and 7.0–9.0 as “agree”. A DI value above one (> 1) indicated a lack of consensus among the participants regarding the association between the statement and the postoperative complication. In addition to the consensus statements, seven general questions were included in the first online survey to assess the experts opinions on the project and their willingness to cooperate in further research. In the first round, the participants were invited to suggest additional items that should be included in the second-round survey. The
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