Evidence map›Paper›PMID 38114245›Full record

ArticleBMJ open quality2023

Multicentre positive deviance seminar to generate best practice recommendations to reduce anastomotic leak and length of stay for patients undergoing oesophagectomy.

Daniel Jones, Molly Gingrich, Caitlin Anstee, Sara Najmeh, Najib Safieddine, Gail Darling, Richard Malthaner, Christian Finley, Daniel G French, Lorenzo Ferri and 1 more

Open access · goldAbstract readMulticenter Study
PubMed Publisher
In one paragraph

Article in BMJ open quality, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
0.3field-weighted citation impact, top 35% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 citations in OpenAlex.

  1. Financial Burden of Postoperative Adverse Events Following Lobectomy: Cost Analysis From 10 High-Volume Canadian Hospitals.European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 2026
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 6 institutions in 1 country.

Daniel JonesSurgery, Thoracic, University of Ottawa, Ottawa, Ontario, Canada danijones@toh.ca.ORCID 0000-0002-9757-0071
Molly GingrichSurgery, Ottawa Health Research Institute, Ottawa, Ontario, Canada.
Caitlin AnsteeSurgery, Ottawa Health Research Institute, Ottawa, Ontario, Canada.
Sara NajmehThoracic and Upper GI, McGill University, Montreal, Quebec, Canada.
Najib SafieddineThoracic Surgery, University of Toronto, Toronto, Ontario, Canada.
Gail DarlingSurgery, Dalhousie University, Halifax, Nova Scotia, Canada.
Richard MalthanerSurgery, London Health Sciences Centre, London, Ontario, Canada.
Christian FinleyThoracic Surgery, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.
Daniel G FrenchThoracic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
Lorenzo FerriThoracic and Upper GI, McGill University, Montreal, Quebec, Canada.
Andrew SeelySurgery, Thoracic, University of Ottawa, Ottawa, Ontario, Canada.
Dalhousie University · CAMcGill University · CAUniversity of Ottawa · CALondon Health Sciences Centre · CASt. Joseph’s Healthcare Hamilton · CAUniversity of Toronto · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundWe describe a novel process using positive deviance (PD) with the Canadian Association of Thoracic Surgeons members, to identify perioperative best practice to minimise anastomotic leak (AL) and length of stay (LOS) following oesophagectomy. To our knowledge, this is the first National combination of level 1 evidence with expert opinion (ie, PD seminar) aimed at reducing AL and LOS in oesophageal surgery. Our primary hypothesis is that a multicentre National PD seminar is feasible, and could lead to the generation of best practices recommendations aimed at reducing AL and LOS in patients with oesophageal cancer.

methodsAdverse events, LOS and AL incidence/severity following oesophagectomy were prospectively collected from seven Canadian thoracic institutions using Thoracic Morbidity and Mortality classification system (2017-2020). Anonymised display of centre's data were presented, with identification of centres demonstrating PD. Surgeons from PD sites discussed principles of care, culminating in the consensus recommendations, anonymously rated by all (5-point Likert scale).

resultsData from 795 esophagectomies were included, with 25 surgeons participating. Two centres were identified as having the lowest AL rates 44/395 (11.1%) (vs five centres 71/400 (17.8%) (p<0.01)) and shortest LOS 8 days 45 (IQR: 6-14) (vs 10 days (IQR: 8-18) (p<0.001)). Recommendations included preoperative (prehabilitation, smoking cessation, chemotherapy for patients with dysphagia, minimise stents/feeding tubes), intraoperative (narrow gastric conduit, intrathoracic anastomosis, avoid routine jejunostomy, use small diameter closed-suction drains), postoperative day (POD) (early (POD 2-3) enteral feeding initiation, avoid routine barium swallow studies, early removal of tubes/drains (POD 2-3)). All ranked above 80% (4/5) in agreement to implement recommendations into their practice.

conclusionWe report the feasibility of a National multicentre PD seminar with the generation of best practice recommendations aimed at reducing AL and LOS following oesophagectomy. Further research is required to demonstrate whether National PD seminars can be an effective quality improvement tool.

Indexed as

Anastomotic LeakEsophageal NeoplasmsCanadaEsophagectomyHumansLength of StayPatient-centred careQuality improvementSurgery

Identifiers

PMID38114245
OpenAlexW4389955619

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.