OGC P38 The impact of hospital experience in bariatric surgery on short-term outcomes after minimally invasive oesophagectomy: a nationwide analysis

Abstract

Abstract Background Minimally invasive oesophagectomy (MIO) is a technically challenging procedure with a substantial learning curve. Composite volume of upper gastrointestinal (upper GI) procedures for cancer has been previously linked to postoperative outcomes. This study aimed to investigate an association between hospital experience in bariatric surgery and short-term outcomes in MIO. Methods Data on oesophagectomy patients between 2016 and 2020 were collected from the Dutch Upper Gastrointestinal Cancer Audit, a mandatory nationwide registry. Hospitals were categorized as bariatric or non-bariatric. Dutch institutions have a mandatory annual threshold of 200 bariatric and 20 oesophagectomy procedures. Multivariable logistic regression investigated short-term postoperative outcomes, adjusting for case-mix. Results Of 3371 patients undergoing oesophagectomy in sixteen hospitals, 2450 (72.7%) underwent MIO. Bariatric hospitals (N=6) accounted for 1057 (43.1%) MIO. Overall postoperative complication rate was lower in bariatric hospitals (59.2% vs. 65.9%, P<0.001). Bariatric hospitals were associated with a reduced risk of overall complications (OR 0.72 [95%CI 0.60-0.87]), length of hospital (OR 0.73 [95%CI 0.61-0.87]) and ICU stay (OR 0.83 [95%CI 0.69-1.00] (P=0.046)) after MIO. Surgical radicality did not differ. Lymph node yield (≥15) was lower in bariatric hospitals (90.0% vs. 94.7%, P<0.001). Several short-term outcomes showed a significantly improving trend over the years in bariatric, but not non-bariatric hospitals. Conclusions In this nationwide analysis, bariatric hospitals were associated with improved short-term outcomes after MIO and further improved over the years. Characteristics of bariatric hospitals that could explain this phenomenon and whether this translates to other upper GI procedures may be warranted to identify.