International Variation in Surgical Practices in Units Performing Oesophagectomy for Oesophageal Cancer: A Unit Survey from the Oesophago-Gastric Anastomosis Audit (OGAA).

Bundred JR; Sivesh Kathir Kamarajah; K Siaw-Acheampong; Dmitri Nepogodiev; Beth Jefferies; P Singh; Richard Malpass-Evans; Ewen A Griffiths; D Alderson; J.A. Gossage; Sean Mckay; I Mohamed; R van Hillegersberg; R Vohra; K Wanigsooriya; T Whitehouse; A Bagajevas; Abate Bekele; R Blanco-Colino; A Da Roit; J El Kafsi-Mawley; A Gjata; Ines Gockel; R G Castro; T Harustiak; P K  Hsu; A Isik; A Kechagias; A Kennedy; B Kidane; H A Mahendran; L Mejia; J I  Moreno; Ionut Negoi; A J  Santiago; R Sayyed; Petra Schneider; S P  Soares; M. Sousa; F R  Takeda; S Vanstraten; B Wallner; Bas P.l. Wijnhoven; M Achiam; T Agustin; A Akbar; A.Z. Al-Bahrani; W. Al-Khyatt; M Albertsmeier; E Alghunaim; B Alkhaffaf; W Allum; F Am; N Andreollo; A Arndt; R Babor; J Barbosa; Raul Bardini bressan; D Beardsmore; G Beban; A Bernardes; Richard Berrisford; A Bianchi; M Bjelovic; A. Boddy; C Bolca; L Bonavina; Gavin Bryce; R  Byrom; R Casaca; Dennis Chan; A. Charalabopoulos; Eun Sun Cheong; F Ciotola; E Colak; C Collins; S Constantinoiu; Rodolfo Costa; M Dahlke; G. Darling; K Dawas; G de Manzoni; A Denewer; M Devadas; S Dexter; S Dikinis; T Dimitrios; J Dolan; C Doung; J H  Egberts; Y Elgharably; M Elhadi; S Elmahi; F A Farias; E Fekaj; J Fernandez; M Forshaw; Juliana Freire; D French; G Gacevski; J Gaedcke; S Gananadha; M M  Gijon; Jay Gokhale; A Gordon; P Grimminger; R Guevara; A Guner; S Gutknecht; H Mahmoodzadeh; I Halldestam; J Hedberg; J Heisterkamp; S Higgs; M Hii; Andrew Hindmarsh; J Hoppner; A Isaza; Jakob R. Izbicki; R Jacobs; Pooja Jain; Jeanette Johansson; B Johnston; J Kafsi; Semagn Kassa; C Kelty; I. Khan; D Khoo; S Khyatt; D Kjaer; D Korkolis; Nicole Kreuser; M. Larsen; P Lau; J Leite; W Lewis; T Liakakos; C Loureiro; A Mahendran; Nicholas David Maynard; Richard McGregor; Stephen McNally; H Medina-Franco; R Meguid; R Melhado; Stewart Mercer; M Migliore; F Mingol; S Mogoanta; Y Mohri; S Monig; J. Moreno; N Motas; T Murphy; S Naqi; R Ni; S. Niazi; S Oglesby; K Okonta; S R Ortiz; Pal K; Fausto Palazzo; A Pascher; M Pascual; G Pata; M Pera; Susana  Puig; J Ramirez; Dimitri A. Raptis; J Rasanen; D Reim; J Reynolds; W Robb; K. Robertson; G Rosero; C Rosman; J Rossaak; J Saarnio; A Santiago; M Schiesser; R R  Scurtu; D Sekhniaidze; B Sevinc; Richard Skipworth; J So; M S Trugeda; A Syed; A M L Takahashi; F Takeda; M Talbot; M Tareen; Mikiko Terashima; M Testini; Nilanjana Tewari; M Tez; M. Thomas; M Tirnaksiz; V Tonini; C C Tu; P Turner; T Underwood; A Uzair; M Vallve-Bernal; Michele Valmasoni; C Vicente; J F Videira; Y Viswanath; J Weindelmayer; R White; D Wigle; Paul M Wilkerson; V Wills; E Zacharakis; Marcela Zuluaga

doi:10.1007/s00268-019-05080-1

International Variation in Surgical Practices in Units Performing Oesophagectomy for Oesophageal Cancer: A Unit Survey from the Oesophago-Gastric Anastomosis Audit (OGAA).

Bundred JR, Sivesh Kathir Kamarajah, K Siaw-Acheampong, Dmitri Nepogodiev, Beth Jefferies, P Singh, Richard Malpass-Evans, Ewen A Griffiths, D Alderson, J.A. Gossage, Sean Mckay, I Mohamed, R van Hillegersberg, R Vohra, K Wanigsooriya, T Whitehouse, A Bagajevas, Abate Bekele, R Blanco-Colino, A Da RoitJ El Kafsi-Mawley, A Gjata, Ines Gockel, R G Castro, T Harustiak, P K Hsu, A Isik, A Kechagias, A Kennedy, B Kidane, H A Mahendran, L Mejia, J I Moreno, Ionut Negoi, A J Santiago, R Sayyed, Petra Schneider, S P Soares, M. Sousa, F R Takeda, S Vanstraten, B Wallner, Bas P.l. Wijnhoven, M Achiam, T Agustin, A Akbar, A.Z. Al-Bahrani, W. Al-Khyatt, M Albertsmeier, E Alghunaim , B Alkhaffaf, W Allum, F Am, N Andreollo, A Arndt, R Babor, J Barbosa, Raul Bardini bressan, D Beardsmore , G Beban, A Bernardes, Richard Berrisford, A Bianchi, M Bjelovic , A. Boddy, C Bolca, L Bonavina, Gavin Bryce, R Byrom, R Casaca, Dennis Chan, A. Charalabopoulos, Eun Sun Cheong, F Ciotola, E Colak, C Collins, S Constantinoiu , Rodolfo Costa, M Dahlke, G. Darling, K Dawas, G de Manzoni, A Denewer, M Devadas, S Dexter, S Dikinis , T Dimitrios, J Dolan, C Doung, J H Egberts, Y Elgharably, M Elhadi, S Elmahi, F A Farias, E Fekaj, J Fernandez, M Forshaw, Juliana Freire, D French, G Gacevski , J Gaedcke, S Gananadha , M M Gijon, Jay Gokhale, A Gordon, P Grimminger , R Guevara , A Guner, S Gutknecht , H Mahmoodzadeh, I Halldestam , J Hedberg, J Heisterkamp , S Higgs, M Hii, Andrew Hindmarsh, J Hoppner, A Isaza, Jakob R. Izbicki, R Jacobs, Pooja Jain, Jeanette Johansson, B Johnston, J Kafsi, Semagn Kassa, C Kelty, I. Khan, D Khoo, S Khyatt, D Kjaer , D Korkolis, Nicole Kreuser, M. Larsen, P Lau, J Leite, W Lewis, T Liakakos, C Loureiro , A Mahendran , Nicholas David Maynard, Richard McGregor, Stephen McNally, H Medina-Franco , R Meguid, R Melhado , Stewart Mercer, M Migliore , F Mingol, S Mogoanta, Y Mohri, S Monig, J. Moreno, N Motas, T Murphy, S Naqi, R Ni, S. Niazi, S Oglesby , K Okonta , S R Ortiz, Pal K, Fausto Palazzo, A Pascher, M Pascual, G Pata, M Pera, Susana Puig, J Ramirez, Dimitri A. Raptis, J Rasanen, D Reim, J Reynolds, W Robb, K. Robertson, G Rosero, C Rosman, J Rossaak, J Saarnio , A Santiago, M Schiesser , R R Scurtu, D Sekhniaidze, B Sevinc, Richard Skipworth, J So, M S Trugeda, A Syed, A M L Takahashi , F Takeda, M Talbot, M Tareen, Mikiko Terashima, M Testini, Nilanjana Tewari, M Tez, M. Thomas, M Tirnaksiz , V Tonini, C C Tu, P Turner, T Underwood, A Uzair, M Vallve-Bernal, Michele Valmasoni, C Vicente, J F Videira, Y Viswanath, J Weindelmayer, R White, D Wigle, Paul M Wilkerson, V Wills, E Zacharakis, Marcela Zuluaga

Research output: Contribution to journal › Article › peer-review

Abstract

Background Anastomotic leaks are associated with significant risk of morbidity, mortality and treatment costs after esophagectomy. 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 esophagectomy. Method The Oesophago-Gastric Anastomosis Audit (OGAA) is an international research collaboration focussed on improving the care and outcomes of patients undergoing esophagectomy. Any unit performing esophagectomy 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 (HIC) and Low/Middle (LMIC) Income countries were defined according to the World Bank whilst unit volume were defined as <20 vs 20-59 vs ≥60 cases/year in the unit. Results Responses were received from 141 units, a 77% (141/182) response rate. Median annual esophagectomy caseload was reported to be 26 (interquartile 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.

Original language	English
Journal	World Journal of Surgery
Early online date	22 Jul 2019
DOIs	https://doi.org/10.1007/s00268-019-05080-1
Publication status	Published - Nov 2019

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10.1007/s00268-019-05080-1

International Variation in Surgical Practices in Units performing Esophagectomy for Esophageal CancerAccepted author manuscript, 140 KB

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JR, B., Kamarajah, S. K., Siaw-Acheampong, K., Nepogodiev, D., Jefferies, B., Singh, P., Malpass-Evans, R., Griffiths, E. A., Alderson, D., Gossage, J. A., Mckay, S., Mohamed, I., van Hillegersberg, R., Vohra, R., Wanigsooriya, K., Whitehouse, T., Bagajevas, A., Bekele, A., Blanco-Colino, R., ... Zuluaga, M. (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. https://doi.org/10.1007/s00268-019-05080-1

@article{00f27246b1a24c7289cc847b7f13eab8,

title = "International Variation in Surgical Practices in Units Performing Oesophagectomy for Oesophageal Cancer: A Unit Survey from the Oesophago-Gastric Anastomosis Audit (OGAA).",

abstract = "Background Anastomotic leaks are associated with significant risk of morbidity, mortality and treatment costs after esophagectomy. 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 esophagectomy. Method The Oesophago-Gastric Anastomosis Audit (OGAA) is an international research collaboration focussed on improving the care and outcomes of patients undergoing esophagectomy. Any unit performing esophagectomy 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 (HIC) and Low/Middle (LMIC) Income countries were defined according to the World Bank whilst unit volume were defined as <20 vs 20-59 vs ≥60 cases/year in the unit. Results Responses were received from 141 units, a 77\% (141/182) response rate. Median annual esophagectomy caseload was reported to be 26 (interquartile 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. ",

author = "Bundred JR and Kamarajah, \{Sivesh Kathir\} and K Siaw-Acheampong and Dmitri Nepogodiev and Beth Jefferies and P Singh and Richard Malpass-Evans and Griffiths, \{Ewen A\} and D Alderson and J.A. Gossage and Sean Mckay and I Mohamed and \{van Hillegersberg\}, R and R Vohra and K Wanigsooriya and T Whitehouse and A Bagajevas and Abate Bekele and R Blanco-Colino and \{Da Roit\}, A and \{El Kafsi-Mawley\}, J and A Gjata and Ines Gockel and Castro, \{R G\} and T Harustiak and Hsu, \{P K\} and A Isik and A Kechagias and A Kennedy and B Kidane and Mahendran, \{H A\} and L Mejia and Moreno, \{J I\} and Ionut Negoi and Santiago, \{A J\} and R Sayyed and Petra Schneider and Soares, \{S P\} and M. Sousa and Takeda, \{F R\} and S Vanstraten and B Wallner and Wijnhoven, \{Bas P.l.\} and M Achiam and T Agustin and A Akbar and A.Z. Al-Bahrani and W. Al-Khyatt and M Albertsmeier and E Alghunaim and B Alkhaffaf and W Allum and F Am and N Andreollo and A Arndt and R Babor and J Barbosa and \{Bardini bressan\}, Raul and D Beardsmore and G Beban and A Bernardes and Richard Berrisford and A Bianchi and M Bjelovic and A. Boddy and C Bolca and L Bonavina and Gavin Bryce and R Byrom and R Casaca and Dennis Chan and A. Charalabopoulos and Cheong, \{Eun Sun\} and F Ciotola and E Colak and C Collins and S Constantinoiu and Rodolfo Costa and M Dahlke and G. Darling and K Dawas and \{de Manzoni\}, G and A Denewer and M Devadas and S Dexter and S Dikinis and T Dimitrios and J Dolan and C Doung and Egberts, \{J H\} and Y Elgharably and M Elhadi and S Elmahi and Farias, \{F A\} and E Fekaj and J Fernandez and M Forshaw and Juliana Freire and D French and G Gacevski and J Gaedcke and S Gananadha and Gijon, \{M M\} and Jay Gokhale and A Gordon and P Grimminger and R Guevara and A Guner and S Gutknecht and H Mahmoodzadeh and I Halldestam and J Hedberg and J Heisterkamp and S Higgs and M Hii and Andrew Hindmarsh and J Hoppner and A Isaza and Izbicki, \{Jakob R.\} and R Jacobs and Pooja Jain and Jeanette Johansson and B Johnston and J Kafsi and Semagn Kassa and C Kelty and I. Khan and D Khoo and S Khyatt and D Kjaer and D Korkolis and Nicole Kreuser and M. Larsen and P Lau and J Leite and W Lewis and T Liakakos and C Loureiro and A Mahendran and Maynard, \{Nicholas David\} and Richard McGregor and Stephen McNally and H Medina-Franco and R Meguid and R Melhado and Stewart Mercer and M Migliore and F Mingol and S Mogoanta and Y Mohri and S Monig and J. Moreno and N Motas and T Murphy and S Naqi and R Ni and S. Niazi and S Oglesby and K Okonta and Ortiz, \{S R\} and Pal K and Fausto Palazzo and A Pascher and M Pascual and G Pata and M Pera and Susana Puig and J Ramirez and Raptis, \{Dimitri A.\} and J Rasanen and D Reim and J Reynolds and W Robb and K. Robertson and G Rosero and C Rosman and J Rossaak and J Saarnio and A Santiago and M Schiesser and Scurtu, \{R R\} and D Sekhniaidze and B Sevinc and Richard Skipworth and J So and Trugeda, \{M S\} and A Syed and Takahashi, \{A M L\} and F Takeda and M Talbot and M Tareen and Mikiko Terashima and M Testini and Nilanjana Tewari and M Tez and M. Thomas and M Tirnaksiz and V Tonini and Tu, \{C C\} and P Turner and T Underwood and A Uzair and M Vallve-Bernal and Michele Valmasoni and C Vicente and Videira, \{J F\} and Y Viswanath and J Weindelmayer and R White and D Wigle and Wilkerson, \{Paul M\} and V Wills and E Zacharakis and Marcela Zuluaga",

year = "2019",

month = nov,

doi = "10.1007/s00268-019-05080-1",

language = "English",

journal = "World Journal of Surgery",

issn = "0364-2313",

publisher = "Wiley",

}

JR, B, Kamarajah, SK, Siaw-Acheampong, K, Nepogodiev, D, Jefferies, B, Singh, P, Malpass-Evans, R, Griffiths, EA, Alderson, D, Gossage, JA, Mckay, S, Mohamed, I, van Hillegersberg, R, Vohra, R, Wanigsooriya, K, Whitehouse, T, Bagajevas, A, Bekele, A, Blanco-Colino, R, Da Roit, A, El Kafsi-Mawley, J, Gjata, A, Gockel, I, Castro, RG, Harustiak, T, Hsu, PK, Isik, A, Kechagias, A, Kennedy, A, Kidane, B, Mahendran, HA, Mejia, L, Moreno, JI, Negoi, I, Santiago, AJ, Sayyed, R, Schneider, P, Soares, SP, Sousa, M, Takeda, FR, Vanstraten, S, Wallner, B, Wijnhoven, BPL, Achiam, M, Agustin, T, Akbar, A, Al-Bahrani, AZ, Al-Khyatt, W, Albertsmeier, M, Alghunaim , E, Alkhaffaf, B, Allum, W, Am, F, Andreollo, N, Arndt, A, Babor, R, Barbosa, J, Bardini bressan, R, Beardsmore , D, Beban, G, Bernardes, A, Berrisford, R, Bianchi, A, Bjelovic , M, Boddy, A, Bolca, C, Bonavina, L, Bryce, G, Byrom, R, Casaca, R, Chan, D, Charalabopoulos, A, Cheong, ES, Ciotola, F, Colak, E, Collins, C, Constantinoiu , S, Costa, R, Dahlke, M, Darling, G, Dawas, K, de Manzoni, G, Denewer, A, Devadas, M, Dexter, S, Dikinis , S, Dimitrios, T, Dolan, J, Doung, C, Egberts, JH, Elgharably, Y, Elhadi, M, Elmahi, S, Farias, FA, Fekaj, E, Fernandez, J, Forshaw, M, Freire, J, French, D, Gacevski , G, Gaedcke, J, Gananadha , S, Gijon, MM, Gokhale, J, Gordon, A, Grimminger , P, Guevara , R, Guner, A, Gutknecht , S, Mahmoodzadeh, H, Halldestam , I, Hedberg, J, Heisterkamp , J, Higgs, S, Hii, M, Hindmarsh, A, Hoppner, J, Isaza, A, Izbicki, JR, Jacobs, R, Jain, P, Johansson, J, Johnston, B, Kafsi, J, Kassa, S, Kelty, C, Khan, I, Khoo, D, Khyatt, S, Kjaer , D, Korkolis, D, Kreuser, N, Larsen, M, Lau, P, Leite, J, Lewis, W, Liakakos, T, Loureiro , C, Mahendran , A, Maynard, ND, McGregor, R, McNally, S, Medina-Franco , H, Meguid, R, Melhado , R, Mercer, S, Migliore , M, Mingol, F, Mogoanta, S, Mohri, Y, Monig, S, Moreno, J, Motas, N, Murphy, T, Naqi, S, Ni, R, Niazi, S, Oglesby , S, Okonta , K, Ortiz, SR, K, P, Palazzo, F, Pascher, A, Pascual, M, Pata, G, Pera, M, Puig, S, Ramirez, J, Raptis, DA, Rasanen, J, Reim, D, Reynolds, J, Robb, W, Robertson, K, Rosero, G, Rosman, C, Rossaak, J, Saarnio , J, Santiago, A, Schiesser , M, Scurtu, RR, Sekhniaidze, D, Sevinc, B, Skipworth, R, So, J, Trugeda, MS, Syed, A, Takahashi , AML, Takeda, F, Talbot, M, Tareen, M, Terashima, M, Testini, M, Tewari, N, Tez, M, Thomas, M, Tirnaksiz , M, Tonini, V, Tu, CC, Turner, P, Underwood, T, Uzair, A, Vallve-Bernal, M, Valmasoni, M, Vicente, C, Videira, JF, Viswanath, Y, Weindelmayer, J, White, R, Wigle, D, Wilkerson, PM, Wills, V, Zacharakis, E & Zuluaga, M 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. https://doi.org/10.1007/s00268-019-05080-1

TY - JOUR

T1 - International Variation in Surgical Practices in Units Performing Oesophagectomy for Oesophageal Cancer: A Unit Survey from the Oesophago-Gastric Anastomosis Audit (OGAA).

AU - JR, Bundred

AU - Kamarajah, Sivesh Kathir

AU - Siaw-Acheampong, K

AU - Nepogodiev, Dmitri

AU - Jefferies, Beth

AU - Singh, P

AU - Malpass-Evans, Richard

AU - Griffiths, Ewen A

AU - Alderson, D

AU - Gossage, J.A.

AU - Mckay, Sean

AU - Mohamed, I

AU - van Hillegersberg, R

AU - Vohra, R

AU - Wanigsooriya, K

AU - Whitehouse, T

AU - Bagajevas, A

AU - Bekele, Abate

AU - Blanco-Colino, R

AU - Da Roit, A

AU - El Kafsi-Mawley, J

AU - Gjata, A

AU - Gockel, Ines

AU - Castro, R G

AU - Harustiak, T

AU - Hsu, P K

AU - Isik, A

AU - Kechagias, A

AU - Kennedy, A

AU - Kidane, B

AU - Mahendran, H A

AU - Mejia, L

AU - Moreno, J I

AU - Negoi, Ionut

AU - Santiago, A J

AU - Sayyed, R

AU - Schneider, Petra

AU - Soares, S P

AU - Sousa, M.

AU - Takeda, F R

AU - Vanstraten, S

AU - Wallner, B

AU - Wijnhoven, Bas P.l.

AU - Achiam, M

AU - Agustin, T

AU - Akbar, A

AU - Al-Bahrani, A.Z.

AU - Al-Khyatt, W.

AU - Albertsmeier, M

AU - Alghunaim , E

AU - Alkhaffaf, B

AU - Allum, W

AU - Am, F

AU - Andreollo, N

AU - Arndt, A

AU - Babor, R

AU - Barbosa, J

AU - Bardini bressan, Raul

AU - Beardsmore , D

AU - Beban, G

AU - Bernardes, A

AU - Berrisford, Richard

AU - Bianchi, A

AU - Bjelovic , M

AU - Boddy, A.

AU - Bolca, C

AU - Bonavina, L

AU - Bryce, Gavin

AU - Byrom, R

AU - Casaca, R

AU - Chan, Dennis

AU - Charalabopoulos, A.

AU - Cheong, Eun Sun

AU - Ciotola, F

AU - Colak, E

AU - Collins, C

AU - Constantinoiu , S

AU - Costa, Rodolfo

AU - Dahlke, M

AU - Darling, G.

AU - Dawas, K

AU - de Manzoni, G

AU - Denewer, A

AU - Devadas, M

AU - Dexter, S

AU - Dikinis , S

AU - Dimitrios, T

AU - Dolan, J

AU - Doung, C

AU - Egberts, J H

AU - Elgharably, Y

AU - Elhadi, M

AU - Elmahi, S

AU - Farias, F A

AU - Fekaj, E

AU - Fernandez, J

AU - Forshaw, M

AU - Freire, Juliana

AU - French, D

AU - Gacevski , G

AU - Gaedcke, J

AU - Gananadha , S

AU - Gijon, M M

AU - Gokhale, Jay

AU - Gordon, A

AU - Grimminger , P

AU - Guevara , R

AU - Guner, A

AU - Gutknecht , S

AU - Mahmoodzadeh, H

AU - Halldestam , I

AU - Hedberg, J

AU - Heisterkamp , J

AU - Higgs, S

AU - Hii, M

AU - Hindmarsh, Andrew

AU - Hoppner, J

AU - Isaza, A

AU - Izbicki, Jakob R.

AU - Jacobs, R

AU - Jain, Pooja

AU - Johansson, Jeanette

AU - Johnston, B

AU - Kafsi, J

AU - Kassa, Semagn

AU - Kelty, C

AU - Khan, I.

AU - Khoo, D

AU - Khyatt, S

AU - Kjaer , D

AU - Korkolis, D

AU - Kreuser, Nicole

AU - Larsen, M.

AU - Lau, P

AU - Leite, J

AU - Lewis, W

AU - Liakakos, T

AU - Loureiro , C

AU - Mahendran , A

AU - Maynard, Nicholas David

AU - McGregor, Richard

AU - McNally, Stephen

AU - Medina-Franco , H

AU - Meguid, R

AU - Melhado , R

AU - Mercer, Stewart

AU - Migliore , M

AU - Mingol, F

AU - Mogoanta, S

AU - Mohri, Y

AU - Monig, S

AU - Moreno, J.

AU - Motas, N

AU - Murphy, T

AU - Naqi, S

AU - Ni, R

AU - Niazi, S.

AU - Oglesby , S

AU - Okonta , K

AU - Ortiz, S R

AU - K, Pal

AU - Palazzo, Fausto

AU - Pascher, A

AU - Pascual, M

AU - Pata, G

AU - Pera, M

AU - Puig, Susana

AU - Ramirez, J

AU - Raptis, Dimitri A.

AU - Rasanen, J

AU - Reim, D

AU - Reynolds, J

AU - Robb, W

AU - Robertson, K.

AU - Rosero, G

AU - Rosman, C

AU - Rossaak, J

AU - Saarnio , J

AU - Santiago, A

AU - Schiesser , M

AU - Scurtu, R R

AU - Sekhniaidze, D

AU - Sevinc, B

AU - Skipworth, Richard

AU - So, J

AU - Trugeda, M S

AU - Syed, A

AU - Takahashi , A M L

AU - Takeda, F

AU - Talbot, M

AU - Tareen, M

AU - Terashima, Mikiko

AU - Testini, M

AU - Tewari, Nilanjana

AU - Tez, M

AU - Thomas, M.

AU - Tirnaksiz , M

AU - Tonini, V

AU - Tu, C C

AU - Turner, P

AU - Underwood, T

AU - Uzair, A

AU - Vallve-Bernal, M

AU - Valmasoni, Michele

AU - Vicente, C

AU - Videira, J F

AU - Viswanath, Y

AU - Weindelmayer, J

AU - White, R

AU - Wigle, D

AU - Wilkerson, Paul M

AU - Wills, V

AU - Zacharakis, E

AU - Zuluaga, Marcela

PY - 2019/11

Y1 - 2019/11

N2 - Background Anastomotic leaks are associated with significant risk of morbidity, mortality and treatment costs after esophagectomy. 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 esophagectomy. Method The Oesophago-Gastric Anastomosis Audit (OGAA) is an international research collaboration focussed on improving the care and outcomes of patients undergoing esophagectomy. Any unit performing esophagectomy 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 (HIC) and Low/Middle (LMIC) Income countries were defined according to the World Bank whilst unit volume were defined as <20 vs 20-59 vs ≥60 cases/year in the unit. Results Responses were received from 141 units, a 77% (141/182) response rate. Median annual esophagectomy caseload was reported to be 26 (interquartile 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.

AB - Background Anastomotic leaks are associated with significant risk of morbidity, mortality and treatment costs after esophagectomy. 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 esophagectomy. Method The Oesophago-Gastric Anastomosis Audit (OGAA) is an international research collaboration focussed on improving the care and outcomes of patients undergoing esophagectomy. Any unit performing esophagectomy 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 (HIC) and Low/Middle (LMIC) Income countries were defined according to the World Bank whilst unit volume were defined as <20 vs 20-59 vs ≥60 cases/year in the unit. Results Responses were received from 141 units, a 77% (141/182) response rate. Median annual esophagectomy caseload was reported to be 26 (interquartile 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.

U2 - 10.1007/s00268-019-05080-1

DO - 10.1007/s00268-019-05080-1

M3 - Article

SN - 0364-2313

JO - World Journal of Surgery

JF - World Journal of Surgery

ER -

International Variation in Surgical Practices in Units Performing Oesophagectomy for Oesophageal Cancer: A Unit Survey from the Oesophago-Gastric Anastomosis Audit (OGAA).

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