International variation in surgical practices in units performing oesophagectomy for oesophageal cancer: A unit survey from the Oesophago-Gastric Anastomosis Audit (OGAA)
International variation in surgical practices in units performing oesophagectomy for oesophageal cancer: A unit survey from the Oesophago-Gastric Anastomosis Audit (OGAA)
BACKGROUND: Anastomotic leaks are associated with significant risk of morbidity, mortality and treatment costs after oesophagectomy. The aim of this study was to evaluate international variation in unit-level clinical practice and resource availability for the prevention and management of anastomotic leak following oesophagectomy.
METHOD: The Oesophago-Gastric Anastomosis Audit (OGAA) is an international research collaboration focussed on improving the care and outcomes of patients undergoing oesophagectomy. Any unit performing oesophagectomy worldwide can register to participate in OGAA studies. An online unit survey was developed and disseminated to lead surgeons at each unit registered to participate in OGAA. High-income country (HIC) and low/middle-income country (LMIC) were defined according to the World Bank whilst unit volume were defined as < 20 versus 20-59 versus ≥60 cases/year in the unit.
RESULTS: Responses were received from 141 units, a 77% (141/182) response rate. Median annual oesophagectomy caseload was reported to be 26 (inter-quartile range 12-50). Only 48% (68/141) and 22% (31/141) of units had an Enhanced Recovery After Surgery (ERAS) program and ERAS nurse, respectively. HIC units had significantly higher rates of stapled anastomosis compared to LMIC units (66 vs 31%, p = 0.005). Routine post-operative contrast-swallow anastomotic assessment was performed in 52% (73/141) units. Stent placement and interventional radiology drainage for anastomotic leak management were more commonly available in HICs than LMICs (99 vs 59%, p < 0.001 and 99 vs 83%, p < 0.001).
CONCLUSIONS: This international survey highlighted variation in surgical technique and management of anastomotic leak based on case volume and country income level. Further research is needed to understand the impact of this variation on patient outcomes.
Underwood, Timothy
8e81bf60-edd2-4b0e-8324-3068c95ea1c6
Oesophago-Gastric Anastomosis Study Group on behalf of the West Midlands Research Collaborative
Underwood, Timothy
8e81bf60-edd2-4b0e-8324-3068c95ea1c6
Oesophago-Gastric Anastomosis Study Group on behalf of the West Midlands Research Collaborative
(2019)
International variation in surgical practices in units performing oesophagectomy for oesophageal cancer: A unit survey from the Oesophago-Gastric Anastomosis Audit (OGAA).
World Journal of Surgery.
(doi:10.1007/s00268-019-05080-1).
Abstract
BACKGROUND: Anastomotic leaks are associated with significant risk of morbidity, mortality and treatment costs after oesophagectomy. The aim of this study was to evaluate international variation in unit-level clinical practice and resource availability for the prevention and management of anastomotic leak following oesophagectomy.
METHOD: The Oesophago-Gastric Anastomosis Audit (OGAA) is an international research collaboration focussed on improving the care and outcomes of patients undergoing oesophagectomy. Any unit performing oesophagectomy worldwide can register to participate in OGAA studies. An online unit survey was developed and disseminated to lead surgeons at each unit registered to participate in OGAA. High-income country (HIC) and low/middle-income country (LMIC) were defined according to the World Bank whilst unit volume were defined as < 20 versus 20-59 versus ≥60 cases/year in the unit.
RESULTS: Responses were received from 141 units, a 77% (141/182) response rate. Median annual oesophagectomy caseload was reported to be 26 (inter-quartile range 12-50). Only 48% (68/141) and 22% (31/141) of units had an Enhanced Recovery After Surgery (ERAS) program and ERAS nurse, respectively. HIC units had significantly higher rates of stapled anastomosis compared to LMIC units (66 vs 31%, p = 0.005). Routine post-operative contrast-swallow anastomotic assessment was performed in 52% (73/141) units. Stent placement and interventional radiology drainage for anastomotic leak management were more commonly available in HICs than LMICs (99 vs 59%, p < 0.001 and 99 vs 83%, p < 0.001).
CONCLUSIONS: This international survey highlighted variation in surgical technique and management of anastomotic leak based on case volume and country income level. Further research is needed to understand the impact of this variation on patient outcomes.
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e-pub ahead of print date: 22 July 2019
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Local EPrints ID: 433504
URI: http://eprints.soton.ac.uk/id/eprint/433504
ISSN: 0364-2313
PURE UUID: 5a7fe072-0baa-45f0-bd9f-2390655af63e
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Date deposited: 23 Aug 2019 16:30
Last modified: 16 Mar 2024 03:35
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Corporate Author: Oesophago-Gastric Anastomosis Study Group on behalf of the West Midlands Research Collaborative
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