Abstract
Abstract
Background
National best practice meetings, combining transparent hospital-level benchmarking and peer-to-peer learning, were introduced in the Netherlands in 2018 to improve outcomes after esophagectomy. This study aimed to investigate the impact of these meetings on national outcomes following esophageal cancer surgery.
Methods
This nationwide population-based cohort study included patients who underwent esophagectomy for cancer registered in the Dutch Upper Gastrointestinal Cancer Audit between 2011 and 2023. Best practice meetings were organized annually from 2018 onwards, except in 2020 because of the COVID-19 pandemic. The primary outcome was the national anastomotic leakage rate. Secondary outcomes included qualitative outcomes and actions after the meetings, assessed using a structured questionnaire. Multilevel multivariable logistic regression compared outcomes 2 years before and after the meetings held in 2018, 2019, and 2021.
Results
A total of 9166 patients were included. Anastomotic leakage increased from 18.6% in 2011 to 20.3% in 2017, then decreased to 14.0% in 2023. Significant overall reductions were observed after the meetings of 2019 (odds ratio 0.65; 95% confidence interval 0.52–0.82) and 2021 (odds ratio 0.78; 95% confidence interval 0.62–0.99). Declines were observed in both cervical and intrathoracic anastomoses. All centers reported implementing improvement actions after the meetings, with 71% rating the meetings as positive and 29% as very positive. Actions included structured site visits and adjustments to surgical techniques, protocols, and care pathways, with key focus areas including anastomotic leakage, lymphadenectomy, and length of hospital stay.
Conclusions
Annual best practice meetings were associated with outcome-oriented actions and significant reductions in national anastomotic leakage rates, suggesting that transparent peer-to-peer sharing of hospital-level outcome data may improve outcomes of esophageal cancer surgery.