PMID- 38358091
OWN - NLM
STAT- MEDLINE
DCOM- 20240307
LR  - 20240307
IS  - 1432-2323 (Electronic)
IS  - 0364-2313 (Linking)
VI  - 48
IP  - 3
DP  - 2024 Mar
TI  - A trans-Canadian positive deviance seminar for paraesophageal hernia surgery: 
      Reporting national postoperative outcomes and consensus recommendations.
PG  - 673-680
LID - 10.1002/wjs.12087 [doi]
AB  - BACKGROUND: The incidence of adverse events (AEs) and length of stay (LOS) varies 
      significantly following paraesophageal hernia surgery. We performed a Canadian 
      multicenter positive deviance (PD) seminar to review individual center and 
      national level data and establish holistic perioperative practice 
      recommendations. METHODS: A national virtual PD seminar was performed in October 
      2021. Recent best evidence focusing on AEs and LOS was presented. Subsequently, 
      anonymized center-level AE and LOS data collected between 01/2017 and 01/2021 
      from a prospective, web-based database that tracks postoperative outcomes was 
      presented. The top two performing centers with regards to these metrics were 
      chosen and surgeons from these hospitals discussed elements of their treatment 
      pathways that contributed to these outcomes. Consensus recommendations were then 
      identified with participants independently rating their level of agreement. 
      RESULTS: Twenty-eight surgeons form 8 centers took part in the seminar across 5 
      Canadian provinces. Of the 680 included patients included, Clavien-Dindo grade I 
      and II/III/IV/V complications occurred in 121/39/12/2 patients 
      (17.8%/5.7%/1.8%/0.3%). Respiratory complications were the most common (effusion 
      12/680, 1.7% and pneumonia 9/680, 1.3%). Esophageal and gastric perforation 
      occurred in 7 and 4/680, (1.0% and 0.6% respectively). Median LOS varied 
      significantly between institutions (1 day, range 1-3 vs. 7 days, 3-8, p < 0.001). 
      A strong level of agreement was achieved for 10/12 of the consensus statements 
      generated. CONCLUSION: PD seminars provide a supportive forum for centers to 
      review best evidence and experience and generate recommendations based on expert 
      opinion. Further research is ongoing to determine if this approach effectively 
      accomplishes this objective.
CI  - (c) 2024 The Authors. World Journal of Surgery published by John Wiley & Sons Ltd 
      on behalf of International Society of Surgery/Societe Internationale de Chirurgie 
      (ISS/SIC).
FAU - Tankel, James
AU  - Tankel J
AUID- ORCID: 0000-0002-2044-2821
AD  - Division of Thoracic and Upper Gastrointestinal Surgery, McGill University Health 
      Center, McGill University, Montreal, Quebec, Canada.
FAU - Safieddine, Najib
AU  - Safieddine N
AD  - Division of Thoracic Surgery, Department of Surgery, Michael Garron Hospital, 
      University of Toronto, Toronto, Ontario, Canada.
FAU - Malthaner, Rick
AU  - Malthaner R
AD  - Division of Thoracic Surgery, Schulich School of Medicine and Dentistry, London 
      Health Sciences Center, Western University, London, Ontario, Canada.
FAU - French, Danny
AU  - French D
AD  - Division of Thoracic Surgery, Department of Surgery, Queen Elizabeth II Hospital 
      (Victoria Campus), Dalhousie University, Halifax, Nova Scotia, Canada.
FAU - Johnston, Brian
AU  - Johnston B
AD  - Division of Thoracic Surgery, Saint John Regional Hospital, Saint John, New 
      Brunswick, Canada.
FAU - Finley, Christian
AU  - Finley C
AD  - Division of Thoracic Surgery, St Joseph's Healthcare, Hamilton, Ontario, Canada.
FAU - Darling, Gail
AU  - Darling G
AD  - Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada.
FAU - Ferri, Lorenzo
AU  - Ferri L
AD  - Division of Thoracic and Upper Gastrointestinal Surgery, McGill University Health 
      Center, McGill University, Montreal, Quebec, Canada.
FAU - Seely, Andrew
AU  - Seely A
AD  - Division of Thoracic Surgery, Department of Surgery, University of Ottawa, 
      Ottawa, Ontario, Canada.
AD  - Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
FAU - Gowing, Stephen
AU  - Gowing S
AD  - Section of Thoracic Surgery, Department of Surgery, Health Sciences Center, 
      University of Manitoba, Winnipeg, Manitoba, Canada.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20240215
PL  - United States
TA  - World J Surg
JT  - World journal of surgery
JID - 7704052
SB  - IM
MH  - Humans
MH  - *Hernia, Hiatal/surgery/complications
MH  - Prospective Studies
MH  - Postoperative Complications/epidemiology/etiology/surgery
MH  - Canada
MH  - Length of Stay
MH  - *Laparoscopy/adverse effects
OTO - NOTNLM
OT  - adverse events
OT  - hospital stay
OT  - laparoscopic
OT  - paraesophageal hernia
OT  - positive deviance
EDAT- 2024/02/15 12:43
MHDA- 2024/03/07 06:43
CRDT- 2024/02/15 08:29
PHST- 2023/11/01 00:00 [received]
PHST- 2024/01/06 00:00 [accepted]
PHST- 2024/03/07 06:43 [medline]
PHST- 2024/02/15 12:43 [pubmed]
PHST- 2024/02/15 08:29 [entrez]
AID - 10.1002/wjs.12087 [doi]
PST - ppublish
SO  - World J Surg. 2024 Mar;48(3):673-680. doi: 10.1002/wjs.12087. Epub 2024 Feb 15.