Delphi Study for the Classification of Recommendations for the RICA Pathway (Enhanced Recovery in Adult Surgery)

This study will use a modified Delphi process conducted remotely through electronic questionnaires. A coordinating committee will prepare an initial list of recommendations based on the previous RICA Pathway document and updated evidence. Expert panelists will rate each recommendation using a 1-to-9 Likert scale and may provide free-text comments. Two Delphi rounds are planned, with a third round if needed for items without sufficient consensus or for reformulated statements. Between rounds, participants will receive aggregated and anonymized feedback, including measures of agreement, median scores, dispersion, and a summary of comments. Consensus for acceptance is predefined as at least 75% of ratings in the 7-9 range and no more than 15% in the 1-3 range. Consensus for rejection is predefined as at least 75% of ratings in the 1-3 range and no more than 15% in the 7-9 range. Items not meeting consensus criteria may be reassessed in subsequent rounds. The analysis will be descriptive and will include response rates, attrition between rounds, item-level agreement, median scores, interquartile ranges, and qualitative thematic review of comments.