Abstract PO-056: The ReTOOL training program for underrepresented minority students: Best practices for virtual training in midst of COVID-19

Background: The Research Training Opportunities for Outstanding Leaders (ReTOOL) Program is an NCI/NIH-funded program (R25CA214225) that focuses on increasing the representation of underserved minority (URM) scientists in biomedical research careers to diversify the cancer research workforce. In addition to didactic curriculum and mentoring, each trainee works with a research mentor who provides hands-on research training experiences during the summer. Responding to the COVID-19 pandemic, the ReTOOL Program was modified to be virtual for the 2020 program. Methods: In response to the COVID19 global pandemic, the ReTOOL program leadership and faculty mentors modified the program element: didactic classes, research training, mentorship, seminars and support networks. The introductory week's independent reading sessions and weekly research seminars remained unchanged, as they were already virtual. Results: 20 students participated in the ReTOOL 2020 program, which started on May 4 and ended on August 7. An online program agreement was created to set expectations about participation, weekly reporting form to ensure trainees met program requirements, and evaluations for continuous monitoring. Specific adjustments that were made included: (1) the one-week preparatory didactic classes were conducted online using Zoom; (2) all research training took place virtually. All wet-lab research-training activities were cancelled, with the 2020 faculty mentors primarily dry-lab scientists and scientists with expertise in secondary data analyses. All trainees worked remotely with dedicated computer/laptop with camera for Zoom video communications, internet and dedicated space for learning. There was access to online library resources through University of Florida (UF); (3) Mentorship was provided with increased frequency of meetings with faculty mentors, program staff and peers; (4) Weekly social event to foster relationships and peer networks. Trainees developed fun, lighthearted activities; and (5) Research showcase with oral presentations through Zoom and innovative use of Twitter for poster sessions. A critical missed opportunity for the trainees was visiting different graduate or professional programs at UF. To fill this gap, we provided funding for each trainee to visit UF later. An advantage of moving the program to a virtual platform was co-mentoring by international mentors in Africa, through the Prostate Cancer Transatlantic Consortium (CaPTC). Additionally, the Service Learning experiences took place virtually. Conclusion: The COVID19 pandemic created an unusual circumstance but we were able to overcome the challenges, which included Zoom fatigue, adjustment to different time zones, isolation and information fatigue. While the ReTOOL research-training program was different in 2020, we were still be able to provide a meaningful experience for the trainees. 2020 trainees submitted 7 conference abstracts and 6 publications. This includes a special series focused on the ReTOOL program projects soon to publish in ecancermedicalscience Journal.

Citation Format: Parisa Fathi, Folakemi Odedina, John Allen, Debra Lyon, Diana Wilkie, Nissa Askins, Brian Seymour. The ReTOOL training program for underrepresented minority students: Best practices for virtual training in midst of COVID-19 [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-056.

Assessing hemodynamics from the photoplethysmogram to gain insights into vascular age: A review from VascAgeNet

The photoplethysmogram (PPG) signal is widely measured by clinical and consumer devices, and it is emerging as a potential tool for assessing vascular age. The shape and timing of the PPG pulse wave are both influenced by normal vascular aging, changes in arterial stiffness and blood pressure, and atherosclerosis. This review summarizes research into assessing vascular age from the PPG. Three categories of approaches are described: 1) those which use a single PPG signal (based on pulse wave analysis), 2) those which use multiple PPG signals (such as pulse transit time measurement), and 3) those which use PPG and other signals (such as pulse arrival time measurement). Evidence is then presented on the performance, repeatability and reproducibility, and clinical utility of PPG-derived parameters of vascular age. Finally, the review outlines key directions for future research to realize the full potential of photoplethysmography for assessing vascular age.

Sex differences in assessing stenosis severity between physician visual assessment and quantitative coronary angiography

BACKGROUND

Physician visual assessment (PVA) in invasive coronary angiography (ICA) is the current clinical method to determine stenosis severity and guide percutaneous coronary intervention. This study sought to evaluate the effect of sex differences in assessing coronary stenosis severity between PVA and quantitative coronary angiography (QCA).

METHODS

209 patients with coronary artery disease (288 coronary lesions) underwent ICA and fractional flow reserve (FFR). ICA image processing including PVA and QCA was used to quantify diameter stenosis (DS). The difference of DS (ΔDS) between PVA and QCA was defined as DS_PVA-DS_QCA. DS ≥50% was considered anatomically obstructive. FFR ≤0.8 was defined as myocardial ischemia.

RESULTS

Mean ± SD age was 63 ± 9 years. There were no significant differences in DS_PVA (61.1 ± 16.3% vs 60.1 ± 18.9%) and DS_QCA (53.1 ± 12.1% vs 55.4 ± 14.3%) between females and males. However, ΔDS between PVA and QCA was higher in females (8.0 ± 10.9%) than in males (4.7 ± 10.9%) (P = 0.03). Thirty-four of 72 vessels (47.2%) in female patients and 75 of 216 vessels (34.7%) in male patients were classified differently by at least one grade using PVA compared to QCA assessment. DS_PVA and DS_QCA were negatively correlated with FFR in females (r_PVA = -0.397, r_QCA = -0.448) with an even stronger negative correlation in males (r_PVA = -0.607, r_QCA = -0.607). ROC analysis demonstrated that DS_QCA had better discrimination capability for myocardial ischemia (FFR ≤ 0.80) than DS_PVA in both sexes (P < 0.05).

CONCLUSIONS

A systematic bias was found in PVA (QCA reference) for overestimating severity of coronary artery disease in females compared to males.

Aligning tumor mutational burden (TMB) quantification across diagnostic platforms: phase II of the Friends of Cancer Research TMB Harmonization Project

BACKGROUND

Tumor mutational burden (TMB) measurements aid in identifying patients who are likely to benefit from immunotherapy; however, there is empirical variability across panel assays and factors contributing to this variability have not been comprehensively investigated. Identifying sources of variability can help facilitate comparability across different panel assays, which may aid in broader adoption of panel assays and development of clinical applications.

MATERIALS AND METHODS

Twenty-nine tumor samples and 10 human-derived cell lines were processed and distributed to 16 laboratories; each used their own bioinformatics pipelines to calculate TMB and compare to whole exome results. Additionally, theoretical positive percent agreement (PPA) and negative percent agreement (NPA) of TMB were estimated. The impact of filtering pathogenic and germline variants on TMB estimates was assessed. Calibration curves specific to each panel assay were developed to facilitate translation of panel TMB values to whole exome sequencing (WES) TMB values.

RESULTS

Panel sizes >667 Kb are necessary to maintain adequate PPA and NPA for calling TMB high versus TMB low across the range of cut-offs used in practice. Failure to filter out pathogenic variants when estimating panel TMB resulted in overestimating TMB relative to WES for all assays. Filtering out potential germline variants at >0% population minor allele frequency resulted in the strongest correlation to WES TMB. Application of a calibration approach derived from The Cancer Genome Atlas data, tailored to each panel assay, reduced the spread of panel TMB values around the WES TMB as reflected in lower root mean squared error (RMSE) for 26/29 (90%) of the clinical samples.

CONCLUSIONS

Estimation of TMB varies across different panels, with panel size, gene content, and bioinformatics pipelines contributing to empirical variability. Statistical calibration can achieve more consistent results across panels and allows for comparison of TMB values across various panel assays. To promote reproducibility and comparability across assays, a software tool was developed and made publicly available.

Sustaining suicide prevention programs in American Indian and Alaska Native communities and Tribal health centers

Background:

Research on sustaining community-based interventions is limited. This is particularly true for suicide prevention programs and in American Indian and Alaska Native (AIAN) settings. Aiming to inform research in this area, this paper sought to identify factors and strategies that are key to sustain suicide prevention efforts in AIAN communities.

Methods:

We used a modified Nominal Group Technique with a purposeful sample of N = 35 suicide prevention research experts, program implementors and AIAN community leaders to develop a list of prioritized factors and sustainability strategies. We then compared this list with the Public Health Program Capacity for Sustainability Framework (PHPCSF) to examine the extent the factors identified aligned with the existing literature.

Results:

Major factors identified included cultural fit of intervention approaches, buy in from local communities, importance of leadership and policy making, and demonstrated program success. Strategies to promote these factors included partnership building, continuous growth of leadership, policy development, and ongoing strategic planning and advocacy. All domains of the PHPCF were representative, but additional factors and strategies were identified that emerged as important in AIAN settings.

Conclusions:

Sustaining effective and culturally informed suicide prevention efforts is of paramount importance to prevent suicide and save lives. Future research will focus on generating empirical evidence of these strategies and their effectiveness at promoting program sustainability in AIAN communities.

Intracranial germ cell tumors in Adolescents and Young Adults: European and North American consensus review, current management and future development

The incidence of intracranial germ cell tumors (iGCT) is much lower in European and North American (E&NA) than in Asian population. However, E&NA cooperative groups have simultaneously developed with success treatment strategies with specific attention paid to long-term sequelae. Neurological sequelae may be reduced by establishing a diagnosis with an endoscopic biopsy and/or cerebrospinal fluid (CSF) and/or serum analysis, deferring the need to perform a radical surgery. Depending on markers and/or histological characteristics, patients are treated as either germinoma or non-germinomatous germ cell tumors (NGGCT). Metastatic disease is defined by a positive CSF cytology and/or distant drops in craniospinal MRI. The combination of surgery and/or chemotherapy and radiation therapy is tailored according to grouping and staging. With more than 90% 5-year event-free survival (EFS), localized germinomas can be managed without aggressive surgery, and benefit from chemotherapy followed by whole ventricular irradiation with local boost. Bifocal germinomas are treated as non-metastatic entities. Metastatic germinomas may be cured with craniospinal irradiation. With a 5-year EFS over 70%, NGGCT benefit from chemotherapy followed by delayed surgery in case of residual disease, and some form of radiotherapy. Future strategies will aim at decreasing long-term side effects while preserving high cure rates.

A critique of measures of emotion and empathy in First Peoples' cultural safety in nursing education: A systematic literature review

BACKGROUND

In Australia, undertaking cultural safety education often evokes strong emotional responses by health students. Despite the potential for emotion to drive transformative learning in this space, measures of emotion are uncommon.

AIM

To review existing tools that intend to measure emotional components of learning in relation to cultural safety education.

METHODS

Articles published in English from January 2005 to January 2020; reported studies from Australia, New Zealand, Canada and United States of America; and measured an emotional construct/s after an education intervention offered to university students enrolled in a health programme were included. Studies were assessed for quality according to the Critical Appraisals Skills Programme criteria.

RESULTS

Eight articles were reviewed; five conducted in the United States of America, and three in Australia. Intervention type, measures, methodological rigour and outcomes varied. Studies predominately measured empathy, guilt and/or fear.

CONCLUSIONS

Although students' emotional responses were measured, processes for students to reflect upon these reactions were not incorporated in the classroom. The review has implications for future research and curricula through developments in measuring and acting upon emotion in cultural safety education for nursing students in Australia.

Forecasting the economic consequences of COVID-19 on longstanding illnesses in Wales

Introduction

The unemployment rate following the COVID-19 pandemic in Wales is increasing and there is a positive link between unemployment and longstanding illnesses. This study aimed to project the percentage of adults with longstanding illnesses and chronic health conditions following COVID-19 associated with the economic consequences.

Methods

We retrieved historical data on the unemployment rates and status of longstanding illnesses among adults from the Office for National Statistics (ONS) and National Survey for Wales (NSW), and used time-series models to project the unemployment rates and percentage of adults with longstanding illnesses and chronic health conditions over a three year period (2020/21 - 2022/23).

Results

Without reparative interventions, the unemployment rate is expected to increase sharply from 3.8% in 2019 to about 7% in 2020 following COVID-19 and then gradually increase over the projected period. With increased unemployment, longstanding illness (LSI) would be expected to increase gradually following COVID-19, with an estimated increase of around or exceeding 4% over three years depending on the LSI measure. There would be a higher increment in the percentage of adults with limiting LSI compared with adults with any LSI, suggesting implications for wider health and social care services. With current unemployment predictions, the percentage of adults with chronic health conditions is projected to increase following the COVID-19 pandemic over the projected period, with a higher increment for mental health and endocrine/metabolic conditions

Conclusions

The longstanding illnesses and chronic health conditions are expected to increase in the coming years following COVID-19 pandemic. Therefore, preventative measures for longstanding illnesses and chronic health conditions should be a priority for a sustainable recovery from the COVID-19.

Key messages

Without reparative interventions, the unemployment rate is expected to increase following the COVID-19 pandemic. The projected prevalence of limiting longstanding illness in adults following COVID-19 suggests implications for wider health and social care services.

COVID-19 impact on financial security: evidence from the National Public Engagement Survey in Wales

Background

A nationally representative COVID-19 Public Engagement Survey for Wales, led by the World Health Organization Collaborating Centre on Investment for Health and Well-being at Public Health Wales, has been ongoing from April 2020, helping to inform a sustainable recovery from the COVID-19 pandemic. A data analysis was performed as part of the Welsh Health Equity Status Report initiative focusing on income and job security, which influences living conditions and lifestyle behaviours.

Methods

A Generalized Linear Model was used to calculate the predicted probability of response for variables of interest, e.g. whether an individual reported being in a worse financial situation due to the pandemic, across the life course, socio-economic gradient and sex. Data collected via telephone between 03 April - 25 July 2020 produced a sample ranging between approx. 2,500 - 7,500 participants. The sample was weighted according to deprivation quintile (using the Welsh Index of Multiple Deprivation), age group and sex.

Results

A significantly higher proportion of survey respondents (18 - 24 years of age) reported being worried about losing their job or not being able to find one, than any other age group. A significantly higher proportion of survey respondents in the most deprived population fifth (33.7%) reported being in a worse financial situation as a result of the restrictions, compared to the least deprived fifth (21.7%).

Conclusions

COVID-19 has had a major impact on people's lives and livelihoods in Wales, hitting the most deprived and vulnerable the most. It has increased job insecurity, especially among younger/working age people. The government has taken unprecedented financial and other measures to address inequities; nevertheless, most are temporary and not specifically targeted to support specific (vulnerable) groups. Measures to promote sustainable economic recovery, job security and safeguarding due to the COVID-19 pandemic need continuity and consistency

Key messages

COVID-19 has had a significant impact on income and job security in Wales, disproportionately affecting the most deprived. To mitigate COVID-19 harms, a continuous and consistent focus on equity is essential to promote sustainable economic recovery.

COVID-19 International Horizon Scanning – informing a response and recovery in Wales and beyond

Issue

The rapidly evolving nature and uncertainties of the COVID-19 pandemic have led to unprecedented challenges for health systems, as well as to wellbeing, social and economic impacts for individuals and communities across the globe. Effective, dynamic, innovative and evidence-based solutions are needed to address these challenges.

Description of Problem

The World Health Organization (WHO) Collaborating Centre on Investment for Health and Well-being, Public Health Wales, has initiated and continues to perform International Horizon Scanning work to inform the evolving COVID-19 public health response and recovery plans in Wales by learning from best practices from other countries. The learning and intelligence is systematically synthesized in rapid regular reports published every week/two weeks. The focus and scope vary, depending on the COVID-19 situation and public health and policy needs.

Results

The work stream has provided Welsh Government, the National Health Service (NHS), Public Health Wales and other key stakeholders with continuous and timely learning from the experience of other countries along with emerging evidence and guidance, provided by key international organisations. This includes international evidence, epidemiological data, experience, measures and recovery approaches, to understand and explore solutions. Reports have given a consistent overview of approaches across countries such as a comparative analysis of the vaccine roll-out or a systematic overview of the R-value and measures implemented accordingly.

Lessons

To understand, mitigate and address the impacts of the pandemic in Wales and beyond, a timely, dynamic and evidence-informed actionable intelligence has proven to be essential to inform and support decision-making on government and health system level to address the pandemic and mitigate harms from COVID-19.

Key messages

International learning has and continues to inform the evolving COVID-19 public health response in Wales.

Public Health Wales is contributing to an evidence-informed inclusive recovery from the pandemic in Wales and beyond.

An observational study of sleep in childhood post-neonatal encephalopathy

AIM

Neonatal encephalopathy (NE) is associated with altered cognitive, motor, sensory abilities and behavioural outcomes. This case-control study aimed to assess whether Quality of Life (QoL) and sleep disorders are affected in older children following NE compared to age-matched controls.

METHODS

Children at school-age post-NE were recruited and compared to age-matched controls. Sleep and QoL were assessed with the Pediatric Quality of Life Inventory and the Child Sleep Habit Questionnaire.

RESULTS

One hundred children were recruited with an age range of 4-6 years, including children post-NE (n=45) and age-matched controls (n = 55). Significantly higher pathological sleep scores were evident in 58% of children post-NE compared to controls (43.8 vs 40.2; p = 0.001). Children post-NE had increased bedtime resistance (p = 0.028) and sleep anxiety (p = 0.01) compared to controls. Children in the post-NE group had lower total QoL scores versus controls (mean score 82.5 vs 95.8; p < 0.01). Children with mild NE also had lower total QoL scores than controls (90.0 vs 95.8, p = 0.003). There was a strong correlation between low QoL with high total sleep scores (Rho 0.339, p = 0.014).

CONCLUSION

There were high rates of sleep issues in school-aged children with mild and moderate-severe NE. Consideration and management of sleep problems may improve QoL in childhood post-NE.

Filtering-induced time shifts in photoplethysmography pulse features measured at different body sites: the importance of filter definition and standardization

Objective.The waveform of a photoplethysmography (PPG) signal depends on the measurement site and individual physiological conditions. Filtering can distort the morphology of the original PPG signal waveform and change the timing of pulse feature points on PPG signals. We aim to quantitatively investigate the effect of PPG signal morphology (related to measurement site) and type of pulse feature on the filtering-induced time shift (TS).Approach.60 s PPG signals were measured from six body sites (finger, wrist under (volar), wrist upper (dorsal), earlobe, and forehead) of 36 healthy adults. Using infinite impulse response digital filters which are common in PPG signal processing, PPG signals were prefiltered (band-pass, pass and stop bands: >0.5 Hz and <0.2 Hz for high-pass filter, <20 Hz and >30 Hz for low-pass filter) and then filtered (low-pass, pass and stop bands: <3 Hz and >5 Hz). Four pulse feature points were defined and extracted (peak, valley, maximal first derivative, and maximal second derivative). For each subject, overall TS and intra-subject TS variability in feature points were calculated as the mean and standard deviation of TS between prefiltered and filtered PPG signals in 50 cardiac cycles. Statistical testing was performed to investigate the effect of measurement site and type of pulse feature on overall TS and intra-subject TS variability.Main results.Measurement site, type of pulse feature, and their interaction had significant impacts on the overall TS and intra-subject TS variability (p < 0.001 for all). Valley and maximal second derivative showed higher overall TS than peak and maximal first derivative. Finger had higher overall TS and lower intra-subject TS variability than other measurement sites.Significance. Measurement site and type of pulse feature can significantly influence the timing of feature points on filtered PPG signals. Filtering parameters should be quoted to support the reproducibility of PPG-related studies.

Accuracy of Peripheral Arterial Disease Registers in UK General Practice: Case-Control Study

Background:

Approximately 20% of the UK population aged 55 to 75 years have evidence of peripheral arterial disease (PAD). PAD affects quality of life and life expectancy if not appropriately diagnosed and managed. At risk patients require accurate diagnosis to ensure optimal treatment to slow disease progression and minimize adverse outcomes.

Aim:

To assess the accuracy of general practice (GP) registration of the diagnosis of peripheral arterial disease (PAD).

Design and Setting:

An observational analytic case-control study. As part of a National Institute for Health Research–funded (ISRCTN13301188) project assessing novel diagnostic methods set in GP practice.

Methods:

A total of 125 patients registered as having PAD and 125 age- and sex-matched controls were recruited from 15 general practices across North East England. The register was then assessed for accuracy of diagnosis. Duplex vascular ultrasound scanning (DUS) undertaken by vascular scientists was used as the gold standard reference for PAD.

Results:

The PAD register had a sensitivity of 86% (95% CI 77%-92%) and specificity of 74% (95% CI 67%-81%) when compared with DUS. The positive predictive value, however, was 69.6% (95% CI 63%-75%) and negative predictive value 88.8% (95% CI 82%-92%). The overall diagnostic effectiveness of the PAD register was 79.2% (95% CI 73%-84%).

Conclusion:

This analysis indicates that while PAD is detected with reasonable sensitivity in primary care, many patients registered with a diagnosis of PAD lacked DUS-proven disease. Improved approaches to the objective diagnosis of PAD may improve diagnosis and management of PAD in primary care.

Deep learning-based photoplethysmography classification for peripheral arterial disease detection: a proof-of-concept study

Objective.A proof-of-concept study to assess the potential of a deep learning (DL) based photoplethysmography PPG ('DLPPG') classification method to detect peripheral arterial disease (PAD) using toe PPG signals.Approach.PPG spectrogram images derived from our previously published multi-site PPG datasets (214 participants; 31.3% legs with PAD by ankle brachial pressure index (ABPI)) were input into a pretrained 8-layer (five convolutional layers + three fully connected layers) AlexNet as tailored to the 2-class problem with transfer learning to fine tune the convolutional neural network (CNN).k-fold random cross validation (CV) was performed (fork = 5 andk = 10), with each evaluated over k training/validation runs. Overall test sensitivity, specificity, accuracy, and Cohen's Kappa statistic with 95% confidence interval ranges were calculated and compared, as well as sensitivities in detecting mild-moderate (0.5 ≤ ABPI < 0.9) and major (ABPI < 0.5) levels of PAD.Main results.CV with eitherk = 5 or 10 folds gave similar diagnostic performances. The overall test sensitivity was 86.6%, specificity 90.2% and accuracy 88.9% (Kappa: 0.76 [0.70-0.82]) (atk= 5). The sensitivity to mild-moderate disease was 83.0% (75.5%-88.9%) and to major disease was 100.0% (90.5%-100.0%).Significance.Substantial agreements have been demonstrated between the DL-based PPG classification technique and the ABPI PAD diagnostic reference. This novel automatic approach, requiring minimal pre-processing of the pulse waveforms before PPG trace classification, could offer significant benefits for the diagnosis of PAD in a variety of clinical settings where low-cost, portable and easy-to-use diagnostics are desirable.

182 Treating Distal Femur Fractures Without Fluoroscopy: Comparison of Implants Used in a Rural Hospital in Tanzania

Introduction

SIGN is a charity providing implants for hospitals with limited resources. There are two nails that can be inserted without fluoroscopy - the standard SIGN nail and the Fin nail. We aimed to evaluate the effectiveness of these implants in treating distal femur fractures.

Method

Retrospective analysis of SIGN database at Nkoaranga Hospital, Tanzania between July 2017 and January 2019. 28 patients (20 male, 8 female) with distal femur fractures had a standard nail (n = 14) or a Fin nail (n = 14). Inclusion criteria: distal femur fractures treated with intramedullary nail. Exclusion criteria: age&lt;16, open injury, antegrade approach, no follow-up at 4 weeks.

Results

Mean age was 41.4 (18-81). Average time from injury to surgery was 29 days. Average first follow-up was 14 weeks (4-73). Painless weight-bearing was achieved in 93% (13/14) of standard nails and 100% (14/14) of Fin nails. Knee flexion &gt;30° was 64% (9/14) in standard nails and 50% (7/14) in Fin nails. Screw loosening was seen in 7% (1/14) in standard nails and no patients with Fin nails. There were no instances of implant breakage, clinical deformity, or infection.

Conclusions

Patients had variable follow-up and presented late causing delayed treatment. Both nails can achieve excellent results. A larger sample size is required.

O61: TEXTBOOK SURGICAL OUTCOMES IN OESOPHAGO-GASTRIC CANCER: THE INFLUENCE OF NATIONAL KEY PERFORMANCE INDICATORS

Introduction

High quality surgery remains the cornerstone of treating oesophago-gastric malignancy. Recent work from the Dutch Upper-gastrointestinal Cancer Audit (DUCA) have defined ten surgical and perioperative ‘textbook’ parameters that correlate with improved overall survival. The aim of this project was to examine the proportion of patients attaining ‘textbook’ outcomes for oesophagectomy and gastrectomy in our unit before and after the introduction of national key performance indicators (KPIs).

Method

A retrospective review of all oesophagectomies and gastrectomies from January 2010 until June 2019 was performed. Clinical, pathological, perioperative, morbidity and mortality outcomes were recorded. 10 ‘textbook’ parameters were studied pre- and post-KPI introduction.

Result

269 and 284 patients underwent oesophagectomy and gastrectomy respectively, 167 pre-KPI and 386 post-KPI. There were no significant differences in age (67.6 vs 66.4 years, p=0.6), gender (71% male, 29% female vs 68% male, 22% female, p=0.48), ASA grade (p=0.6) or tumour stage (p=0.37) pre- and post-KPI. In the pre-KPI era, 28/167 (17%) patients achieved all ten textbook parameters, compared with 157/386, (41%, p=0.001) post-KPI. This compares favourably to DUCA ‘textbook’ data. There was an improvement in adequate lymphadenectomy (56% vs 83%, p=0.002), a reduction in margin positivity (21% vs 7%, p= 0.001) and peri-operative mortality (6% vs 2%, p=0.03) post-KPI.

Conclusion

There has been a significant improvement in perioperative outcomes in esophagectomy following the introduction of national KPIs in our unit. The number of patients achieving ‘textbook’ outcomes is comparable with international standards. The identification of textbook parameters allows further focus for future quality improvement initiatives.

Take-home message

National KPIs improve peri-operative outcomes in oesophago-gastric cancer.