A Video-Based Procedure-Specific Competency Assessment Tool for Minimally Invasive Esophagectomy

Author:

Ketel Mirte H. M.1,Klarenbeek Bastiaan R.1,Eddahchouri Yassin1,Cheong Edward2,Cuesta Miguel A.3,van Daele Elke4,Ferri Lorenzo E.5,Gisbertz Suzanne S.67,Gutschow Christian A.8,Hubka Michal9,Hölscher Arnulf H.10,Law Simon11,Luyer Misha D. P.12,Merritt Robert E.13,Morse Christopher R.14,Mueller Carmen L.5,Nieuwenhuijzen Grard A. P.12,Nilsson Magnus1516,Pattyn Piet4,Shen Yaxing17,van den Wildenberg Frits J. H.18,Abma Inger L.19,Rosman Camiel1,van Workum Frans118

Affiliation:

1. Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands

2. The PanAsia Surgery Group, Mount Elizabeth Hospital, Singapore

3. Department of Surgery, Amsterdam University Medical Centers, Location VUmc, Amsterdam, the Netherlands

4. Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium

5. Department of Surgery, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada

6. Amsterdam UMC location University of Amsterdam, Surgery, Amsterdam, the Netherlands

7. Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands

8. Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland

9. Department of Thoracic Surgery, Virginia Mason Medical Center, Seattle, Washington

10. Department for General, Visceral and Trauma Surgery, Elisabeth-Krankenhaus-Essen GmbH, Essen, Germany

11. Department of Surgery, Queen Mary Hospital, School of Clinical Medicine, The University of Hong Kong, Hong Kong

12. Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands

13. Department of Surgery, Ohio State University Wexner Medical Center, Columbus

14. Department of Thoracic Surgery, Massachusetts General Hospital, Boston

15. Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden

16. Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden

17. Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China

18. Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands

19. IQ Healthcare, Radboud University Medical Center, Nijmegen, the Netherlands

Abstract

ImportanceMinimally invasive esophagectomy (MIE) is a complex procedure with substantial learning curves. In other complex minimally invasive procedures, suboptimal surgical performance has convincingly been associated with less favorable patient outcomes as assessed by peer review of the surgical procedure.ObjectiveTo develop and validate a procedure-specific competency assessment tool (CAT) for MIE.Design, Setting, and ParticipantsIn this international quality improvement study, a procedure-specific MIE-CAT was developed and validated. The MIE-CAT contains 8 procedural phases, and 4 quality components per phase are scored with a Likert scale ranging from 1 to 4. For evaluation of the MIE-CAT, intraoperative MIE videos performed by a single surgical team in the Esophageal Center East Netherlands were peer reviewed by 18 independent international MIE experts (with more than 120 MIEs performed). Each video was assessed by 2 or 3 blinded experts to evaluate feasibility, content validity, reliability, and construct validity. MIE-CAT version 2 was composed with refined content aimed at improving interrater reliability. A total of 32 full-length MIE videos from patients who underwent MIE between 2011 and 2020 were analyzed. Data were analyzed from January 2021 to January 2023.ExposurePerformance assessment of transthoracic MIE with an intrathoracic anastomosis.Main Outcomes and MeasuresFeasibility, content validity, interrater and intrarater reliability, and construct validity, including correlations with both experience of the surgical team and clinical parameters, of the developed MIE-CAT.ResultsExperts found the MIE-CAT easy to understand and easy to use to grade surgical performance. The MIE-CAT demonstrated good intrarater reliability (range of intraclass correlation coefficients [ICCs], 0.807 [95% CI, 0.656 to 0.892] for quality component score to 0.898 [95% CI, 0.846 to 0.932] for phase score). Interrater reliability was moderate (range of ICCs, 0.536 [95% CI, −0.220 to 0.994] for total MIE-CAT score to 0.705 [95% CI, 0.473 to 0.846] for quality component score), and most discrepancies originated in the lymphadenectomy phases. Hypothesis testing for construct validity showed more than 75% of hypotheses correct: MIE-CAT performance scores correlated with experience of the surgical team (r = 0.288 to 0.622), blood loss (r = −0.034 to −0.545), operative time (r = −0.309 to −0.611), intraoperative complications (r = −0.052 to −0.319), and severe postoperative complications (r = −0.207 to −0.395). MIE-CAT version 2 increased usability. Interrater reliability improved but remained moderate (range of ICCs, 0.666 to 0.743), and most discrepancies between raters remained in the lymphadenectomy phases.Conclusions and RelevanceThe MIE-CAT was developed and its feasibility, content validity, reliability, and construct validity were demonstrated. By providing insight into surgical performance of MIE, the MIE-CAT might be used for clinical, training, and research purposes.

Publisher

American Medical Association (AMA)

Subject

Surgery

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