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

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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.

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Data availability

The data that support the findings of this study are available on request from the Dutch Upper-Gastrointestinal Clinical Audit (DUCA) scientific committee. The data are not publicly available due to Dutch privacy legislation.

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Acknowledgements

The authors would like to thank all surgeons, registrars, physician assistants, and administrative nurses for their contribution to the data registration in the DUCA database, and the Dutch Upper GI Cancer Audit group for scientific input during the application of our study.

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Authors and Affiliations

  1. Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands

    Henricus J. B. Janssen, Tessa C. M. Geraedts, Geert A. Simkens, Ignace H. J. T. de Hingh, Grard A. P. Nieuwenhuijzen, Misha D. P. Luyer & Simon W. Nienhuijs

  2. Department of Cancer and Surgery, Imperial College London, London, UK

    Geert A. Simkens

  3. Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands

    Maurits Visser

  4. Department of Surgery, ZGT Hospital Group Twente, Almelo, The Netherlands

    Marc J. van Det

  5. Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands

    Richard van Hillegersberg

  6. Department of Electrical Engineering, University of Technology Eindhoven, Eindhoven, The Netherlands

    Misha D. P. Luyer

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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 Hillegersberg, Misha D.P. Luyer and Simon W. Nienhuijs have no conflicts of interest or financial ties to disclose.

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Janssen, H.J.B., Geraedts, T.C.M., Simkens, G.A. et al. The impact of hospital experience in bariatric surgery on short-term outcomes after minimally invasive esophagectomy: a nationwide analysis. Surg Endosc 38, 720–734 (2024). https://doi.org/10.1007/s00464-023-10560-6

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