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Postoperative outcomes in oesophagectomy with trainee involvement

Postoperative outcomes in oesophagectomy with trainee involvement
Postoperative outcomes in oesophagectomy with trainee involvement

BACKGROUND: The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting.

METHODS: Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups.

RESULTS: Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005).

CONCLUSION: Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery.

Anastomosis, Surgical/adverse effects, Anastomotic Leak/etiology, Cohort Studies, Esophageal Neoplasms/surgery, Esophagectomy/methods, Humans
2474-9842
Underwood, Timothy
8e81bf60-edd2-4b0e-8324-3068c95ea1c6
Oesophago-Gastric Anastomosis Study Group (OGAA) on behalf of the West Midlands Research Collaborative
Underwood, Timothy
8e81bf60-edd2-4b0e-8324-3068c95ea1c6

Oesophago-Gastric Anastomosis Study Group (OGAA) on behalf of the West Midlands Research Collaborative (2022) Postoperative outcomes in oesophagectomy with trainee involvement. BJS Open, 5 (6). (doi:10.1093/bjsopen/zrab132).

Record type: Article

Abstract

BACKGROUND: The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting.

METHODS: Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups.

RESULTS: Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005).

CONCLUSION: Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery.

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More information

Accepted/In Press date: 15 November 2021
e-pub ahead of print date: 17 January 2022
Keywords: Anastomosis, Surgical/adverse effects, Anastomotic Leak/etiology, Cohort Studies, Esophageal Neoplasms/surgery, Esophagectomy/methods, Humans

Identifiers

Local EPrints ID: 456210
URI: http://eprints.soton.ac.uk/id/eprint/456210
ISSN: 2474-9842
PURE UUID: 628097d4-7950-4f8a-8d95-cb475202bec6
ORCID for Timothy Underwood: ORCID iD orcid.org/0000-0001-9455-2188

Catalogue record

Date deposited: 26 Apr 2022 17:05
Last modified: 28 Apr 2022 01:52

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Corporate Author: Oesophago-Gastric Anastomosis Study Group (OGAA) on behalf of the West Midlands Research Collaborative

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