Defining, Evaluating, and Managing Postoperative Respiratory Depression: An e-Delphi Study

BACKGROUND: Postoperative respiratory depression (PORD) is a common but underreported postoperative pulmonary complication with potentially serious short- and long-term consequences. Despite its prevalence, no universally accepted expert definition exists, making identification, diagnosis, and epidemiologic study challenging. METHODS: An e‑Delphi study was conducted with a multidisciplinary panel of 10 board‑certified physicians in anesthesiology, surgery, pulmonology, emergency medicine, and critical care. Over four rounds, panelists anonymously rated 20 literature‑derived statements on PORD definition, diagnosis, risk factors, monitoring, prevention, and management using a 1-10 Likert scale. A consensus threshold of ≥70% agreement was applied. Panelists could suggest revisions, and statements were ranked by relative importance. RESULTS: Nineteen of 20 statements (95%) achieved consensus; 15 reached consensus within two rounds, and four additional statements reached consensus by round four. The most important statement defined PORD as a clinically significant reduction in neural drive to breathe, indicated by respiratory rate