219. ASSOCIATION BETWEEN VIDEO-BASED SURGICAL PERFORMANCE AND PATIENT OUTCOMES IN MINIMALLY INVASIVE ESOPHAGECTOMY IN THE NETHERLANDS

Abstract Background Increasing evidence shows substantial variation in surgical performance measured by a (video-based) competency assessment tool (CAT). Moreover, suboptimal has been associated with less favorable patient outcomes complex minimal invasive procedures. It is likely this also applies for minimally esophagectomy (MIE). In previous study CAT MIE (MIE-CAT) was developed and validated. The present investigated the association between postoperative of Netherlands. Methods A nationwide observational video analysis performed. All fifteen Dutch hospitals performing voluntarily submitted all from 2020–2021 Upper-GI Clinical Audit registry, two representative videos 2022. Surgical assessed 7 blinded independent expert surgeons MIE-CAT. Hospitals were divided into quartiles based on their score. Multilevel logistic regression, clustering patients within hospitals, used to associations outcomes. Primary outcome severe complications (Clavien-Dindo ≥3) 30 days after surgery. Results Highest- (mean MIE-CAT 113.6, SD 5.5, n = 3) versus lowest-performance-quartile 94.1, 5.9, had more experience (Pearson’s r 0.74, 95%CI 0.32–0.92), larger volumes 0.46, -0.13-0.81) (Figure 1). Performance highest- lowest-quartile statically significantly (severe (RR, converted OR, 0.50, 0.24–0.99), peroperative (RR 0.21, 0.04–0.94) any 0.54, 0.24–0.96)), conversions 0.21–0.21) 11.5% absolute chance reduction an average patient. Increased anastomotic-phase anastomotic leakage 0.14, 0.06–0.31). Conclusion This showed statistically significant clinically relevant undergoing MIE. An complication when operated highest-performance quartile hospital, compared lowest-performance hospital. These findings show that good essential aspect clinical