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

Henricus J B Janssen; Tessa C M Geraedts; Geert A Simkens; Maurits Visser; Ignace H J T de Hingh; Marc J van Det; Grard A P Nieuwenhuijzen; Richard van Hillegersberg; Misha D P Luyer; Simon W Nienhuijs

doi:10.1007/s00464-023-10560-6

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

Surg Endosc. 2024 Feb;38(2):720-734. doi: 10.1007/s00464-023-10560-6. Epub 2023 Dec 1.

Affiliations

¹ Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands. thijs.janssen@catharinaziekenhuis.nl.
² Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
³ Department of Cancer and Surgery, Imperial College London, London, UK.
⁴ Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands.
⁵ Department of Surgery, ZGT Hospital Group Twente, Almelo, The Netherlands.
⁶ Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
⁷ Department of Electrical Engineering, University of Technology Eindhoven, Eindhoven, The Netherlands.

PMID: 38040832
DOI: 10.1007/s00464-023-10560-6

Abstract

Background: Minimally invasive esophagectomy (MIE) 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 MIE.

Method: Data on esophagectomy 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. Multivariable logistic regression investigated short-term postoperative outcomes, adjusting for case mix.

Results: Of 3371 patients undergoing esophagectomy in sixteen hospitals, 2450 (72.7%) underwent MIE. Bariatric hospitals (N = 6) accounted for 1057 (43.1%) MIE. Annual volume of bariatric procedures was median 523 and esophagectomies 42. In non-bariatric hospitals, volume of esophagectomies was median 52 (P = 0.145). 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 (aOR 0.76 [95% CI 0.62-0.92]), length of hospital (aOR 0.79 [95% CI 0.65-0.95]), and ICU stay (aOR 0.81 [95% CI 0.67-0.98]) after MIE. Surgical radicality (R0) did not differ. Lymph node yield (≥ 15) was lower in bariatric hospitals (90.0% vs. 94.7%, P < 0.001). Over the years, several short-term outcomes improved in bariatric hospitals compared to non-bariatric hospitals.

Conclusion: In this nationwide analysis, there was an association between bariatric hospitals and improved short-term outcomes after MIE. Characteristics of bariatric hospitals that could explain this phenomenon and whether this translates to other upper GI procedures may be warranted to identify.

Keywords: Bariatric surgery; Esophageal cancer; Minimally invasive esophagectomy; Nationwide analysis; Short-term outcomes.

MeSH terms

Bariatric Surgery* / adverse effects
Esophageal Neoplasms* / pathology
Esophageal Neoplasms* / surgery
Esophagectomy / adverse effects
Esophagectomy / methods
Hospitals
Humans
Laparoscopy* / methods
Minimally Invasive Surgical Procedures / methods
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Postoperative Complications / surgery
Retrospective Studies
Treatment Outcome