1. Oesophago-Gastric Surgical Quality Improvement Alliance (OG-SQILL)
Multicentre national observational cohort study on variation in peri-operative care pathways following major oesophago-gastric resection
Christopher Peters1, Tom Drake2, Chia Kong3, Krishna Moorthy1, and Olga Tucker4 on behalf of the Oesophago-Gastric Surgical Quality Improvement Alliance (OG-SQILL)
2Department of Surgery, Imperial College London 2Department of Clinical Surgery, University of Edinburgh
3Department of Medicine, University of Glasgow 4Department of Surgery, University of Birmingham
Background
Centralisation of oesophago-gastric (OG) cancer resections has led to substantial improvements in perioperative care with a reduction in post-operative mortality. However, morbidity rates remain high, with significant variation across UK centres in key outcomes. A multicentre prospective observational cohort study was performed to evaluate current practice and variation in peri-operative pathways of care.
Methods
11 UK centres prospectively recorded patient demographics, operative details and peri-operative management for consecutive patients undergoing elective oesophago-gastric resections during a 3-month period.
Figure 4: Median length of time intubated during and after oesophagectomy (extreme outliers not shown).
Results
p=0.06
Figure 5: Proportion of patients at each centre with a serious complication (Clavien-Dindo 3 or higher).
Figure 1: Numbers of gastrectomies and oesophagectomies performed in each centre.
p=<0.005
Figure 6: Median length of stay in days for patients following gastrectomies (extreme outliers not shown). Overall median 9 days (variation between centres 8-13).
Figure 7: Median length of stay in days for patients following oesophagectomies (extreme outliers not shown). Overall median 14 days (variation between centres ).
Figure 2: Proportion of all cases performed at least in part laparoscopically.
Conclusion
Whilst outcomes following oesophago-gastric resection have improved in recent years this study has confirmed substantial variation in peri-operative care pathways. A national focus on standardisation of peri-operative care pathways and refinement of multidisciplinary care, with sharing of best practice, may further improve morbidity and mortality rates.
Figure 3: Destination following oesophagectomy.
Oesophago-Gastric Surgical Quality Improvement Alliance (OG-SQILL)
Ravinder Vohra, Dmitri Nepogodlev & Olga Tucker, University Hospitals Birmingham
Sacheen Kumar & Krishna Moorthy, St Mary’s Hospital, London
Waleed Al Khyatt, Andrew Duncan, Sherif Awad, Syed Y Iftikhar & Paul Leader, Derby
Hospitals NHS foundation trust
Alex Harris, Mohamed Elshaer & Ahmed Al-Baharani, West Hertfordshire NHS Trust
Caruana Clifford, Andrew Davies & James Gossage, St Thomas’s Hospital, London
Tom Drake, University of Edinburgh
Christopher Peters & Asif Chaudry, Royal Marsden NHS Foundation Trust
Dariush Kamali & Y K S Viswanath, South Tees Hospitals NHS Foundation Trust
Waduud Mohammed, Francesca Savioli & Matthew Forshaw, Glasgow Royal Infirmary
Michelle Slater & Bruno Sgromo, Oxford University Hospitals NHS Foundation Trust
Samantha Body & Stuart Mercer, Portsmouth Hospitals NHS Trust
Max Almond & Oliver Priest, University Hospital of North Staffordshire
Chia Kong, University of Glasgow
0161 P109