Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries
Authors:   ESCP EAGLE Safe Anastomosis Collaborative and NIHR Global Health Research Unit in Surgery, Avellaneda Nicholas , Al Masri Mahmoud , Baimakhanov Abylai , Balasubramaniam Dinesh , Bhangu Aneel , Bouchagier Konstantinos , Bozbiyik Osman , Carpelan Anu , Chwat Carina , Cunha Miguel , Dawson Brett E , Mallen Maria Victoria Duque , Ellebæk Mark Bremholm , Gonzalez Tomás Elosua , Elshami Mohamedraed , Fakhradiyev Ildar , Ozkan Omer Faruk , Fleres Francesco , Futaba Kaori , Gallo Gaetano , Ghosh Dhruv , Glasbey James C , Harrison Ewen , Hooper Richard L , Jain Ritu , Kamarajah Sivesh , Veetil Sreejith Kannummal , Kamer Erdinc , Keatley James , Knowles Charles H , Kulimbet Mukhtar , Lal Pawanindra , Li Elizabeth , Polamreddy Bala Mahesh , Minaya-Bravo Ana , Mittal Rohin , Morton Dion Gregory , Nadal Luis Roberto Manzione , Negoi Ionut , Nepogodiev Dmitri , Omar Omar , Pata Francesco , Pinkney Thomas , Potter Mark A , Rottoli Matteo , Santos Guilherme , Smith Iain , Spinelli Antonino , Venn Mary , Hooper Richard , Morton Dion , Bywater Edward , Evans Jonathan , Magill Laura , McKay Siobhan , Bordom Daniel Osei , Simões Joana , Venn Mary L , Adeyeye Ademola , Avellaneda Nicolas , Buchs Nicolas , Cato Liam , Finch David , Umar Garzali Ibrahim , Bravo Ana Minaya , Junior Helio Moreira , Neary Peter , Poskus Tomas , Roslani April , Samadov Elgun , Sbaih Mohammed , Shalaby Mostafa , Singh Baljit , Sinha Aad , Vardanyan Armen , Chaudhry Sanjay , Frasson Matteo , Millward Jim , Sánchez-Guillén Luis , Schmitz Niels-Derrek , Stijns Jasper , Zimmerman David D E , Beard David , Campbell Marion , Moug Susan , Aytac Erman , Blackwell Sue , Buchwald Pamela , Chowdhury Sharfuddin M , Dardanov Dragomir , Dulskas Audrius , Elhadi Muhammed , El-Hussuna Alaa , Garoufalia Zoe , Aslam Muhammad Imran , Kelly Michael , Knowles Charles , Mendes Beatriz , Ng Simon , Pellino Gianluca , Sebastian Shaji , Sivrikoz Emre , Tejedor Patricia , Vaizey Carolynne , Bianchi Romina , Christensen Peter , Lee Suk-Hwan , Lohsiriwat Varut , Mantoo Surendra Kumar , Mazlan Luqman , Um Jun Won , Wang Jaw Yuan , Watanabe Jun , Yao Hongwei , Bengueddach Aicha , Tidjane Anisse , Tabeti Benali , Behilil Chakib , Boudjenan-Serradj Nabil , Bensafir Salim , Meharzi Sif El Islam , Aissat Abdenour , Ghouali Amine Khayreddine , Larabi Khadidja , Riffi Omar , Kacimi Salah Eddine Oussama , Mesli Smain Nabil , Rezoug Walid , Mitidieri Alejandro , José Alvarado , Pablo Chaves , Rodriguez Cristian Ariel , Panettiere Maria Florencia , Barbalace Nicolas , Juan Tricarico , Lucena Jose , Houdin Anabella , Fernandez Eugenia , Lococo Julio , Pedro Luis , Loban Mariana , Vecchio Pablo , Grinblat Ariel , Carrie Augusto , Veracierto Federico , Santillan Mateo , Napolitano Milena , Rosa Sonia La , Gonzalez Carla Mariela , Ferro Ezequiel , Muñoz Juan Pablo , Ventorutti Tatiana , Cabrera Claudia , Carrizo Claudia , Mospane Claudio , Leiro Fabio , Espino Julieta , Trama Mauro , Potolicchio Analia , Dindri Franco , Buey Lourdes , Lucas Nicolas , Catalano Pablo , Astilleta Romina , Quiroga Yenny , Valli Diego , Alexandre Flavia , Martres Gladys , Rosato Guillermo , Lemme Gustavo , Romero Veronica , Doniquian Alejandro Marcelo , Pachajoa Diana Alejandra Pantoja , Llahi Florencia , Fiorenza Juan Maria , Parodi Matias , Ocaña Noelia , Gallardo Alfredo , Valenzuela Andres , Perriello Juan , Nador Rodolfo , Fermani Claudio , Garay Lorena , Blanco Pablo , Villalobos Santiago , Posner Federico , Vieyra Nicolas , Fiorito Pablo , Ciabattari Paula , de Kort Chantal , Daryanani Deepu , Smit Justin , Gosselink Martijn Pieter , Janssen Nadeche , Feiss Anna , Lee Chun Hin Angus , Taylor Danielle , Edington John , Chen Nevin , Ong Wei Ming , Aigner Felix , Moitzi Gabriele , Gemes Geza , Braumille Markus , Mitteregger Martin , Gerald Seitinger , Uranitsch Stefan , Belarmino Armin , Waha James , Kahn Judith , Treiber Michael , Schemmer Peter , Mikalauskas Saulius , Ibrahimli Arturan , Orujova Elnara , Namazov Ilgar , Alikhanli Jhale , Asgarov Mohsum , Kutkut Aymen , Almahmeed Ebrahim , Aljawder Hasan , Juma Isam , Johnston Keith , Saeed Mirza Faraz , Khairi Sara , Matovic Ervin , Omerasevic Mediha , Delibegovic Samir , Hodzic Samir , Rudell Angela Genoefa , Fuzari Jamile , Farah José Francisco , Dos Santos Maria Beatriz Alves , Lupinacci Renato Arioni , Pereira Talison Silas , da Silveira Sete Alexandre , Filho Antônio Lacerda , de Souza Pires Bruno Lucena , de Queiroz Fábio Lopes , Amaral Hélida Aline Tomacheski , Dos Santos Marco Antônio Miranda , de Miranda Silvestre Simone Chaves , Hanan Bernardo , Reis Claudilaine , Cassia Gabriela , da Luz Magda , Delgado Marina , Campanati Renato , Silva Rodrigo , Bomfa-Barbosa Alysson , Alves Brenda Chayanny , Costa Breno Xaia Martins , Cortes Bruno Giusti Werneck , Lemos Fernando Henrique Teodoro , Arreguy-Borges Kanthya , Silva Thaisa Barbosa , Assis Ana , Freitas Antonio Hilário , Rezende Daniel , Silva Helio , Alvarenga Isabella , Cascais Raquel , Silva Thaisa , Pinto Henrique , Silva Ilson , Leite Lílian , Massahud Matheus , Meyer Matheus , Tibúrcio Rafael , Martinez Carlos Augusto Real , Espinha Daniela Roncoletta , Marson Fernando Augusto Lima , de Oliveira Góes Igor Arantes , de Souza Artioli Luana Maria , Boschiero Matheus Negri , Takahashi Carina Yumi , de Oliveira Flávia Gomes , Junior Humberto Fenner Lyra , de Oliveira João Carlos Costa , Dos Santos José Mauro , Gerber Marlus Tavares , Erdmann Thomas Rolf , Barbosa Anderson , Fernandes Andre , Júnior Ayr Nasser , Júnior Helio Moreira , Moreira José , Ribeiro Mara , Moreira Pedro , Carvalho Alexandre , Santos Bianca , Fidelis Flávia , Cruz Isabela , Codes Lina , Aibe Raquel , Boudoux Sabrina , Favacho Bernard Costa , Pinto Fabio , Gava Guilherme , Pivati Isabela Ramos , Vilain Luciano Ferreira , Kim Nam , Nunes Rafael Leite , Dimitrov Dobromir , Peneva Kristin , Karamanliev Martin , Dimitrova Slavina , Ivanov Tsvetomir , Atanasov Boyko , Dzharov Georgi , Shtereva Maria , Slavchev Mihail , Belev Nikolay , Krastev Panche , Arabadzhiev Angel , Tonova Dimitrina , Tzoneva Dochka , Sokolov Manol , Gribnev Petar , Maslyankov Svilen , Pavlov Vasil , Bakmaz Bernarda , Dijan Emilio , Ćoza Ivo , Mihanovic Jakov , Kučić Jurica , Sulen Nina , Katušić Zvonimir , Hudáček Kamil , Farkašová Martina , Marková Miriam , Grolich Tomáš , Kala Zdeněk , Pazdírek Filip , Hoch Jiří , Filipová Lenka , Kocián Petr , Přikryl Petr , Høgn Anders , Møller Betina , Slot Dorthe Katrine , Bælum Jens Kristian , Cour Kenn La , Eriksen Niels Damgaard , Mahmoud Abdelrahman , Abdellatif Ahmed , Nafea Ahmed , Ewedah Moataz , Soliman Mohamed , Yakout Nadia , Argawy Osama , Sallam Ibrahim , Kamel Inas , Sherif Mohamed , Ashmawy Soad , Ali Ahmed , Saad Mahmoud , Ahmed Manar , Mohamed Mohamed , Mohamed Nada , Mahmoud Samir , Mahmoud Shereen , Rashed Amier Mohamed , Abd-Errazik Mohammad Ahmad , Ammar Mona Ahmed , Mohammed Rabab , Ebrahem Aamal , Abd El Aal Ahmed , Abdou Khaled , Wagdy Michael , Qassem Mohamed , Taha Mohamed , El-Wafa Yahya Abou , Shehta Ahmed , El Metwally Aziza , Hamed Hosam , Ali Mahmoud Abdelwahab , Elrefai Mohamad , El Sorogy Mohamed , Abdelkhalek Mostafa , Ragab Ahmed , Refky Basel , Metwally Islam H , Abdelkhalek Mohamed , Kamal Mohamed , Zuhdy Mohammad , Shetiwy Mosab , Sakr Ahmad , Elfallal Ahmed , Elfeki Hossam , Eldakroury Israa , Elbahrawy Khaled , Mostafa Mohamed , Emile Sameh , Tessema Abdi , Tasew Alelign , Gezahegn Habtamu , Bekele Kebebe , Belay Million , Gudisa Zewude , Teferu Zinash , Väyrynen Antti , Kechagias Ari , Turunen Arto , Katunin Jevgeni , Parhiala Mikael , Pengerma Pasi , Lahti Petra , Vihervaara Hanna , Huhtinen Heikki , Pasonen Jaana , Heino Riitta , Pakarinen Sakari , Falenius Ville , Pinard Béatrice , Nobile Camille , Duchalais Emilie , Drissi Farouk , Meurette Guillaume , Podevin Juliette , Lepenndu Marguerite , Hoetzel Alexander , Jud Andreas , Jauch Dominik , Stefan Fichtner-Feigl , Neeff Hannes , Holzner Philipp , Nguyen Philipp , Ryl Alice , Kehl Franz , Pullig Frieder , Baral Jörg , Münch Steffen , Fütterer Carsten , Reißfelder Christoph , Sandra-Petrescu Flavius , Herrle Florian , Hardt Julia , Lamm Lena , Seyfried Steffen , Gharbi Akram , Aydin Funda , Stavrou Gregor , Sperber Jonas , de Deken Julie , Schwarzkopf Konrad , Widyaningsih Rizky , Polidorou Andreas , Mpakas Aristidis , Tokidis Evris , Loun Lounta , Petropoulou Thalia , Balalis Dimitrios , Korkolis Dimitrios , Manatakis Dimitrios , Assimakopoulou Elena , Bourazani Maria , Gklavas Antonios , Kalamara Eirini , Papaconstantinou Ioannis , Theodoraki Kassiani , Chardalias Leonidas , Konstadoulakis Manousos , Theodosopoulos Theodosios , Soulioti Eleftheria , Kavezou Foteini , Filippou Jana , Papadoliopoulou Maria , Michalopoulos Nikolaos , Vassiliu Pantelis , Sidiropoulos Theodoros , Charakopoulou Alexandra , Panagiotou Anna , Kokkinakis Konstantinos , Lambridi Electra , Psarologos Michail , Maria Sotiropoulou , Giannaraki Styliani , Kapiris Stylianos , Triantafyllou Alexandra , Theodoropoulos Charalampos , Matthaiou Georgia , Westzaan Natalia , Etelka Santo , Triantafyllou Tania , Theodoropoulos G , Schizas Dimitrios , Mpaili Eustratia , Karydakis Lysandros , Mpoura Maria , Danassi Despoina , Karavokyros Ioannis , Dimitriou Nikoletta , Livanou Xrysoyla , Kikira Athanasia , Tsourouflis Gerasimos , Tomara Nefeli-Kaiti , Nikiteas Nikolaos , Dorovinis Panagiotis , Tsiotos Gregory , Stamou Konstantinos , Kocka Neriada , Ballian Nikiforos , Kalakonas Spyros , Athanasakis Elias , Chrysos Emmanuel , Xynos Evangelos , Tsiaoussis John , Papadaki Kyriaki , Xenaki Sofia , Nyktari Vasileia , Sarakatsianou Chamaidi , Bompou Effrosyni , Arnaoutoglou Eleni , Tzovaras George , Baloyiannis Ioannis , Mamaloudis Ioannis , Perivoliotis Konstantinos , Apostolidi Eirini , Mulita Francesk , Karpetas Georgios , Maroulis Ioannis , Vailas Michail , Petra Angeliki , Kontis Elissaios , Kaouras Emmanouil , Katsaros Ioannis , Katsiaras Lykourgos , 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, Lee Hyeongon , Baek Jeong-Heum , Nam Kug Hyun , Lee Kyung Cheon , Lee Won-Suk , Jeon Youngbae , Kim Chang Woo , Park Sang-Eun , Son Gyung Mo , Ahn Hong Min , Lee In Young , Kim Tae Kyun , Pcolkins Andrejs , Sivins Armands , Lobovs Dmitrijs , Ancans Guntis , Kreice Ilona , Budnikova Ina , Jelovskis Ivans , Emhareb Abdalla , Abaidalla Ahmed , Hammed Amane , Khairallah Marwan , Jibreel Salma Saleh , Mohmmad Walid A S , Hasan Wisam , Venskutonis Donatas , Daugėla Edvardas , Dainius Edvinas , Juočas Juozas , Kutkevičius Juozas , Vaitkutė Kristina , Bradulskis Saulius , Macas Andrius , Pauzas Henrikas , Jokubauskas Mantas , Lizdenis Paulius , Budrikienė Rima , Svagzdys Saulius , Saladzinskas Zilvinas , Volkoviene Gerda , Makauskiene Jolanta , Kuliavas Justas , Bernotaite Vlada , Danys Donatas , Kontrimaviciute Egle , Poskus Eligijus , Kryzauskas Marius , Jakubauskas Matas , Jotautas Valdemaras , Zakaria Andee Dzulkarnaen , Kai Micheal Wong Pak , Zainy Rhendra Hardy Mohamad , Tan Shong Sheng , Zain Wan Zainira Wan , Zakaria Zaidi , Yusoff Zakiah Mohd , Raduan Farhana , Sagap Ismail , Razali Noor Yanti Fazlina , Rahman Nurafdzillah Abdul , Kanthan Soma Balaganapati Chandra , Nie Yeoh Chih , Azman Zairul Azwan Mohd , Ang Chin Wee , Tang Chu Yik , Poh Keat Seong , Ng Kevin , Hashim Norhayati Mohd , Xavier Ruben , Khong Tak Loon , Amir Ahmad Suhaimi , Ali Che Saniati Che , Yew Chor Kuan , Henry Fitjerald , Muniandy Jothinathan , Baharom Salahudin , Eng Stanley Chee Ren , Hu Felicia Su-Min , Amin-Tai Hizami , Jabar Mohd Faisal , Satar Mohd Hady Shukri Abdul , Fathi Nik Qisti , Rao Prashanti Surichandra , Podesta Anne Marie Camilleri , Cini Charles , Psaila Josephine , Debono Marianne , Sammut Matthew , Spiteri Neville , Andrejevic Predrag , Muro Adriana Galaviz , Leon Benicia Perez , Perez Jesus Alonso Valenzuela , Quiñonez Jose Raul Acosta , Vera Marina Teresa Ramirez , Gutierrez Victor Manuel Maciel , Bobadilla Billy Jimenez , Martinez Claudia Martinez , de León Rendón Jorge Luis , Hererro Juan Antonio Villanueva , Cuichan Marco Vinicio Yugsi , Baez Noelia Fernández , Prevost Patsy Garduño , Hoyos-Torres Alejandro , Ruiz-Muñoz Erick Alejandro , Alvarez-Bautista Francisco Emmanuel , Ortíz-Méndez Guillermina , Zamudio-Bautista Jorge Luis , Salgado-Nesme Noel , Vergara-Fernández Omar , Sanchez-Valdivieso Enrique , Martinez Gregoria , Navarrete-Aleman Jaime , Perez-Arellano Jorge , Maldonado-Barron Rebeca , Hernandez-Krauss Rosy , Ousadden Abdelmalek , Benjelloun El Bachir , Bzikha Ilham , Ibnmajdoub Karim , Mazaz Khalid , Marghich Omar , Touzani Soumaya , Benkabbou Amine , Souadka Amine , El Ahmadi Brahim , Zaari Fatimazahraa , Laamri Imad , Majbar Mohammed Anass , Mohsine Raouf , Van Charles Berlo , Seuren Danielle , Gillissen Freek , Aarts Frits , Konsten Joop , Van Maarten Heinsbergen , Schlooz Sjef , Naiqiso Alena , Merrie Arend , Varghese Chris , Pugh Felicity , Bissett Ian , Wilson Kasmira , Mitchell Simon , Dawson Carmel , Hill Charlotte , Wright Deborah , Hubley Shelley , Lin Anthony , Jones Deborah , Siggins Lauren , Fagan Paul , Wu Scott , Ekwesianya Andrew , Nwoye Chukwuemeka , Agara Daniel , Ejiofor Gloria , Sundaynweke Nneka , Kwentoh Nwanneka , Ewah Richard , Aremu Abdurrahman , Ballah Abubakar , Ningi Adamu , Ohia Ernest , Mienda Isa , Aliyu Mohammed , Oloko Nasirudeen , Okunlola Abiodun , Abiyere Henry , Bolanle Olajide Edward , Babatunde Olanrewaju , Fatudimu Samuel , Orewole Tesleem , Mba Emmanuel Louis , Felix Michael Shalzim , Abdulfatah Mustapha , Ibrahim Naziru , Masoro Umar , Fakoya Adegbolahan , Irabor David , Anyadike Florence , Ulasi Ikechukwu , Orji Mathias , Afuwape Oludolapo , Ayandipo Omobolaji , Aremu Isiaka , Adegboye Kazeem , Gbadegesin Peter , Aminu Bashiru , Aghadi Ifeanyi Kene , Makama Jerry Godfrey , Joshua Samaila , Kache Stephen Akau , Sheshe Abdulrahman Abba , Bala Abubakar Muhammad , Garzali Ibrahim Umar , Abdullahi Mustapha Miko Mohammed , Muhammad Nasiru , Umar Nura Aliyu , Muhammad Saminu , Okoye Aloysius , Emegoakor Chiemelu , Nwosu Chimdiebele , Egwuonwu Ochonma Amobi , Ekwunife Okechukwu , Amadigwe Rita , Ojiakor Samuel , Akere Abidemi , Okereke Chukwuma , Olaleye Oluwaseun , Ige Oluwasuyi , Olubayo Oyetunde , Olatiilu Tope , Idris Mohammad , Shehu Ahmad , Oluyori Dupe , Nwabuoku Emeka , Ukwubile Linus , Bashir Mohammed , Daniyan Muhammad , Rauf Hareem , Ali Madeeha , Zakaria Maheen , Hameed Malika , Amanullah Nazli , Chawla Tabish , Waqar Usama , Jamal Abid , Butt Anam , Kerawala Asad , Samson Samuel , Dodhy Afia Arshed , Gill Aun Jamal , Malik Awais , Ali Danish , Mohsin Hassan , Afzal Muhammad Farooq , Batool Sana , Suleman Ayra , Khalid Junaid , Zafar Madiha , Dilawar Maha , Janjua Muhammad Haris , Sarwar Muhammad Zeeshan , Naqi Syed Asghar , Akbar Ali , Afzal Ameer , Anwar Jamal , Gondal Khalid Masud , Shaukat Maria , Waheed Mariam , Sohail Mohammad , Mukhtiar Nida , Ammar Ahmed Siddique , Hussain Ahsan , Khan Alam Noor , Sarwar Albash , Khan Imran , Khattak 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António , Lareiro Catarina , Martins Ruben , Revez Tatiana , Martins Ana , Cardoso Diogo , Alegre Inês , Estevão Pedro , Andrade Diogo , Gomes Diogo Carrola , Duarte Maria José , Custódio Pedro , Nemésio Rodrigo Athayde , Rodrigues Susana , Correia Angela , Domingos Hugo , Herrando Ignacio , Azevedo Jose , Fernandez Laura , Azevedo Patricia , Vieira Pedro , Torre Ana , Amado Andreia , Paiva Manuela , Saraiva Raquel , Costa Sílvia , Mendes Tanya , Queirós Tatiana , Silva Albano , Faustino Ana , Freitas António , Mendes Joana , Amaral Luis , Quintanilha Rui , Silva Rui , Coelho Ana Margarida , Ribeiro Ana , Pinto Carla , Ribeiro Nuno , Reis Rui , Costa Susana , Fernandes Vania , Sanches Ana , Amorim Edgar , Miguel Inês , Rachadell Juan , Sanches Madalena , Oliveira Sandra , Baptista Victor , Roxo Alberto , Devesa Helena , Teslyak Olena , Barradas Renato , Marques Sónia , Martins Sónia , Pepino Susana , Silva Alberto , Deus Ana Cláudia , Ferreira Andreia , Marinho Diogo , Sousa Diogo , 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Davidovskaja Larisa , Burlov Nikita , Mankevich Nikolay , Tverdohlebova Tatyana , Bogatikov Alexander , Lodygin Alexander V , Krasnoselsky Constantin , Vasiukova Evgeniia-Surgeon , Kopteyev Nikita R , Ovchinnikov Timofey , Kashchenko Victor A , Novikova Anastasia , Terentyeva Ekaterina , Kuleshov Oleg , Pavlov Rostislav , Koshel Andrey , Kostromitsky Dmitry , Drozdov Evgeniy , Klokov Sergey , Camacho Amparo , Khan Farhat N , Bandar Mahdi Al , Shamim Rafia , Chowdhury Sharfuddin , Kovacevic Bojan , Krdzic Igor , Zdravkovic Maja , Kenic Marko , Milentijevic Milica , Petkovic Natasa , Radulovic Radosav , Ngu James , Teo Nan Zun , Singh Prit Anand , Ong Suet Yan , Li Sun , en Siew Bei , Chee Corissa , Koh Jasmin Jia Min , Lee Kai Yin , Tan Ker Kan , Wong Siew Ching , Loh Will , Pujol Andrea Fernandez , Rubio Javier Corral , Farrés Laia Pagés , Vendrell Laura Lopez , Del Olmo Maria Inmaculada Ureña , Pedregosa Ana Belen , Galmes Carla , Luckute Daiva , Casanova Daniel , Artigot Mariano , Guedes Xavier , Olivella Yolanda , Sarda Marc Sadurni , Toscano Marta Jimenez , Damieta Marta Pascual , Pera Miguel , Gonçalvez Sandra Alonso , Galvez Sandra Torres , Ruiz Silvia Salvans , Espin-Basany Eloy , Marinello Franco , Villarino-Villa Laura , Heras Marisol Vega-Las , Martin-Sanchez Rocio , Mata Rodrigo Mata , Blanco-Colino Ruth , Otero Ana , de Lacy Antonio Maria , Sanahuja Josep Marti , Bravo Raquel , Ferraz Teresa , Gonzabay Victor , Gonzalez Felix , Menendez Pablo , Del Castillo Vanesa Crespo Garcia , Lopez-Pelaez Vicente Muñoz , Silva Álvaro Soler , Lillo-García Cristina , Tauler Elena Miranda , Manresa Maria Carmen Estañ , Pérez Sandra Lario , Llopis Saray Quinto , Rubio Ainhoa Valle , Castillo Enrique Roca , Miramón Francisco Javier Jiménez , Rodriguez Jose Luis Ramos , Rizo-Lamberti Laura Alonso , Garrido Pilar Garcia , Carneros Virginia Jimenez , Alfonso Beatriz Amorós , Sierra Begoña González , Amador Cristina García , Gomendio Maria Dolores Picardo , Palomino María Victoria Romo , de La Plaza Llamas Roberto , Cafranga Estíbaliz Gutiérrez , Ramos Juan Luis Esteban , Estudillo Marta Copano , Pérez Raquel Escalera , Pernas Rosa María , de Lebrusant Fernández Sara , Bautista Wilson Manuel Sánchez , Llamazares Ana Llamazarez , Valbuena Ana Lozano , Moran Laura Alvarez , Alvarez Laura Jimenez , Raposo Lourdes Galan , Ceron Silvia Ferrer , Calvo Almudena Castro , Valcárcel Cristina Rey , Peña Jose Perez , Gómez Luis Miguel Jimenez , Díez Miguel Cuende , Lindenbaum Paula Dujovne , Mata Silvia Kayser , Ruiz-De-La-Hermosa Alicia , Abad-Motos Ane , Toribio-Combarro Begoña , Ripollés-Melchor Javier , Fuenmayor-Valera Maria Luisa , Ortega-Domene Patricia , Loscos Ana , Del Pueblo Cristina Sanchez , Dziakova Jana , Mugüerza José María , Carlin Patricia Saez , Anula Rocio , Mouvet Yvonne , Forero-Torres Alexander , Andrés Beatriz Díaz San , Marcos Camino Morales , Rubio Ines , Pascual Isabel , Yague Julio , Alcolea Natalia González , Alonso Alfredo , Diéguez Beatriz , Ibañez Ildefonso , Pérez Jose Luis , Losada Manuel , García-Conde María , Hernández Miguel , Blazquez-Martin Alma , Vera-Mansilla Cristina , Mendoza-Moreno Fernando , Hernandez-Salvan Javier , Diez-Alonso Manuel , Hernandez-Juara Pilar , Barrena-Blazquez Silvestra , Minaya-Bravo Ana María , Galván-Pérez Armando , Miguel-Méndez Carlos San , Gonzalez-Gonzalez Enrique , Alvarez-Díez Marcos , García-Ureña Miguel Ángel , Llorente-Moreno Miriam , Ruiz-Lozano Carlos , Colás-Ruiz Enrique , Pérez-Calvo Javier , Gomila-Sanso Joan Andreu , Álvarez-Llano Laura , Serrano-Fuentes Silvia Covadonga , Soto-Montesinos Cristina , Dedeu-Bastardas Imma , Perez-Reche Isabel , Labró-Ciurans Meritxell , Pardo-López Sara , Pérez Elisa García , Fernández Ignacio Ortega , Canals Lucía Otazu , Espino Pablo Calvo , Ruano Paloma Guillamot , Ricardo Villamarín , Ros Emilio Peña , Manuel Esther Medina , Buleje Jorge Alejandro Benavides , Prats María Milagros Carrasco , Baños Pedro Antonio Parra , González Pilar Martínez , Celdrán Rebeca González , Pellicer-Franco Enrique M , Valero-Navarro Graciela , Vicente-Villena Juan Pablo , Martinez-Mercader Maria Mar , Baeza-Murcia Melody , Mengual-Ballester Monica , Soria-Aledo Victoriano , Fernández-Martínez Daniel , Varela-Rodríguez Lorena , Garcia-Flórez Luis Joaquin , Fernández-Hevia Maria , Gonzalez-Diaz Maria Jose , Fernández-Arias Sebastian , Puertas Cristina Palomar , de San Pío Carvajal Eduardo , Cebolla Elena Sagarra , Brainsa Eneida , Bayo José Manuel Muros , Castro Marta Cuartero , Blanco Raquel Ríos , Gutierrez Elsa , Pinto Francisca Lima , Alegre Javier Martinez , Flores Natalia , ÓSullivan Sara Nuñez , Fernández Begoña Fadrique , Alonso Javier Etreros , Conde Juan Guillermo Ais , Ropero Nicolas Monge , Bayón Raquel Álvaro , Dominguez Sara Hernández , Ramirez Sofia , Martin de Pablos Angel , Perez-Sanchez Asuncion , Cano-Matias Auxiliadora , Del-Rio-Lafuente Francisco-Javier , Caballero-Delgado Javier , Valdes-Hernandez Javier , Gomez-Rosado Juan-Carlos , Martinez Cristina , Cholewa Hanna , Sancho-Muriel Jorge , Alberola Maria José , Navasquillo Mireia , Primo Vicent , Moreno Virginia , Espí-Macías Alejandro , Moro-Valdezate David , Carrascosa-Morales Irene , Martín-Arévalo José , Soro-Domingo Marina , García-Botello Stephanie , Pla-Marti Vicente , Abellán Antonio Melero , Pérez Carolina Martínez , Cortés Guillermo Felipe Valderas , Blasco Laura Fraile , Chornet Marta Roselló , Martín Rosa Sanchis , Diego Alejandro Romero-De , Vázquez-Fernández Andrea , Pascual Antonia , de Andrés-Asenjo Beatriz , Beltrán de Heredia Juan , Ruiz-Soriano María , Rodríguez-Jiménez Rita , Iribarren Enrique Moncada , Rodríguez Erene Victoria Flores , Del Carmen Casas García Maria , García-Señoráns Marta Paniagua , Valderrama Óscar Cano , Rodríguez Paula Fernández , Santos Raquel Sánchez , Currás Rosana Pérez , Vigorita Vincenzo , Roche Carlos Gracia , Delgado Eduardo , Lafuente Francisco , Gascon Isabel , Saudi Sef , Fraj Victoria , Gómez M E , Santos E G , Mena E A , Mantecón J V , García S S , Fernández-Camuñas A , Wickramasinghe Dakshitha , de Zoysa Ishan , Samarasekera Nandadeva , Wickramarathne Rasika , Dassanayake Vihara , Balathayalan Yathev , de Silva Dulantha , Perera Mariyan , Pulleperuma Samanthi , Jayasekara Sharitha , Wijenayake Wasantha , Gunetilleke Bhagya , Abeysinghe Nayana , Chandrasinghe Pramodh , Kumarage Sumudu , Abdalradiy Abdalrahmman G , Widatalla Abu Bakr H , Ahmed Amjed Yassir , Mohamed Haiba A , Hamid Hytham K S , Ali Manhal Hashim , Eldin Sami Jalal , Agger Erika , Jutesten Henrik , Lindgren Jenny , Lepsenyi Mattias , Azhar Najia , Hansdotter Pernilla , Ekepil Anna , Lindén Åsa , Brandström Gustav , Smedberg Jannica , Schiffer Eduardo , Ris Frédéric , Longchamp Grégoire , Meyer Jeremy , Dupret Luc , Galetti Ken , Regusci Luca , Grischott Marco , Malugani Michela , Mouhandes Abd El-Fattah , Danial Aghyad Kudra , Khayat Michel , Sbahi Mohamad Hussam Eddin , Marawy Mohamad Kher , Abdullah Mohammad Amer , Douba Zain , Mansour Ali , Niazi Ammar , Hamza Amr , Mohamad Aya Haji , Awead Marwa , Mohammad Saleh , Salloum Samer , Jabar Ahmad Al , Zazo Aya , Shebli Baraa , Ayoub Kusay , Younes Lina , Bannoud Mohammad Hassan , Zazo Rama , Saad Ahmad , Hamdan Alaa , Wakkaf Habib , Adra Lama , Souliman Mahmoud , Anton Majd , Hannouf Sawsan , Li Kuan Lin , Cheng Kuang I , Ji Shi Jie , Hsieh Yi Chien , Parlak Emine Arici , Demir Mehmet , Kara Umut , Peker Yaşar Subutay , Yiğit Direnç , Unal Neslisah , Iflazoğlu Nidal , Yalkin Ömer , Topal Serra , Gulcu Baris , Ozturk Ersin , Gümbelek Gülnur , Terkanlıoğlu Serkan , Koklucan Arzu , Ince Gorkem , Sen Murat , Isik Ozgen , Kural Said , Akesen Selcan , Yilmazlar Tuncay , Sungurtekin Hulya , Sungurtekin Ugur , Vural Ummuhan , Ozgen Utku , Isik Arda , Onk Didem , Kurnaz Eray , Ozker Turkan Sel , Ipek Ahmet , Ferlengez Aysegul , Erturk Candeniz , Tatar Cihad , Sevik Husnu , Akay Omer , Sensoy Ozlem , Hayirlioglu Mehmet Bilhan , Aktas Serhat , Ozben Volkan , Aliyeva Zumrud , Mutlu Arda Ulaş , Gökay Banu Vural , Saraçoğlu Can , Aytaç Erman , Gülmez Mehmet , Işık Merve Ünal , Hacim Adnan , Akbas Ahmet , Soyhan Filiz , Turgut Mehmet Alim , Demirgan Serdar , Meric Serhat , Altinel Yuksel , Baris Baver , Akova Elif , Kahraman Ersin , Kucuk Hasan Fehmi , Saracoglu Kemal Tolga , Kaya Selcuk , Lel Sude , Gurbulak Esin Kabul , Caz Esra , Kostek Mehmet , Mihmanli Mehmet , Yazici Pinar , Oba Sibel , Kırkan Emre Furkan , Ulgur Hanife Seyda , Kalın Murat , Dinkci Mustafa Deniz , Duzgun Ozgul , Ozturk Sevgi , Zengin Abdullah Kağan , Aşkar Ahmet , Şanlı Ahmet Necati , Erginöz Ergin , Özçelik Mehmet Faik , Ergün Sefa , Uludağ Server Sezgin , Kara Dilek , Yılmaz Gülseren , Sarıcı Inanç Şamil , Kara Yasin , Incesu Aylin , Arican Can , Atici Semra Demirli , Kaya Tayfun , Gezer Turna , Kirmizi Yasemin , Aydin Gaye , Namdaroglu Ozan , Adakaya Sıla , Canda Aras Emre , Ozzeybek Deniz , Coskun Nurcan , Sokmen Selman , Ozkardesler Sevda , Bisgin Tayfun , Miftari Almir , Caliskan Cemil , Akgun Erhan , Avseren Goksu , Deniz Nuri , Yoldas Tayfun , Güreşin Alican , Zayakov Georgi , Pösteki Gökhan , Utkan Nihat Zafer , Tatar Ozan Can , Akçay Özlem , Güler Sertaç Ata , Mantoğlu Barış , Demirel Emel , Akın Emrah , Gonullu Emre , Altintoprak Fatih , Palabıyık Onur , Bayhan Zülfü , Ciftci Ahmet Burak , Colak Elif , Aybar Engin , Celik Hale Kefeli , Eraslan Huseyin , Yemez Kursat , Ozbilgin Sadan Somuncuoglu , Senol Serdar , Gultekin Fatma Ayca , Piskin Ozcan , Guler Ozkan , Karadere Yucel , Kakeeto Andrew , Oguttu Benson , Sikakulya Franck K , Lule Herman , Rybachuk Alena , Shudrak Anatoliy , Beznosenko Andriy , Lisnyy Ivan , Rozhkova Veronika , Zvirych Vitalii , Alawlaqi Dina , El Jamali Faek , Balooshi Iman Al , Ahmed Masood , Albers Michael , Ali Noura Al , Church Robert , Dudas Gabor , Wells Johanna , Pavlova Milena , Sebastiani Simone , Paterson Christine , Kaushal Manish , Patel Panna , Panchal Sanjay , Handa Siddhartha , Tezas Stergios , Zaidi Syed-Nadeem , Raj Gracy , Wright Jonathan , Hallam Sally , Karandikar Sharad , Gates Zoe , Marshall Alison , Thompson Amari , Tennakoon Athula , Rao Milind , Callan Rory , Tufail Sabeen , Rajendran Ganesh , Polisetty Kiran , Husain Najam , Clarke Nicola , Naranayanasamy Sangara , Hallett Abigail , Lorejo Emmanuel , Ward Nicholas , Antakia Ramez , Xanthis Athanasios , Simillis Constantinos , Tweedle Elizabeth , Panagiotopoulou Ioanna , Grimes Lisa , Mounstephen Lorraine , Bocancia Raluca , Carden Claire , Lynch Joanna , Noveros Ma Salome , Shaalan Ramy , Khalil Tarek , Marshall William , Hodge Katherine , Balfour James , Mcintosh Katrina , Buijs Louis , Yule Michael , Vaughan-Shaw Peter G , Smith Scott , Anderson Tom , Mcdermott Frank D , Daniels Ian R , Tapp Judy , Smart Neil , Rajaretnam Niroshini , Bethune Robert , Clark Thomas , Delimpalta Christina , Liao Christopher , Banham Gail , Induruwage Lalani , Velchuru Vamsi , Lawrence Anna , Rahman Atiqur , Bennett James , Badawi Marwa , Harshen Raj , Bhargava Aman , Gorrela Kalyani , Jumah Maher , Hanson Matthew , Arya Shobhit , Atendido Tiffany , Shrestha Ashish , Cook Esther , Rakhimov Iskandar , Collins Jen , Alamin Nadeen , Vigneswaran Natalia , Basnyat Pradeep , Shamardal Aliaa , Chacko Anil , Wanshantha Dinamulla , Bisheet George , Ebdewi Hamdi , Abdellatif Mohamed , Adu-Poku Patricia , Tore Anil , Adams Ferdinand , Allen Kate , Ahmed Khalil , Kulkarni Nikhil , Chitnis Abhishek , Patel Hitesh , Magsino Jim , Sarodaya Varun , Minicozzi Annamaria , Dempsy Charlotte , Ahmed Haleemasahdia , Jayasinghe Jayan Dewantha , Okail Mohamed Hazem , Thaha Mohamed , Hallworth Stephen , Parmar Chetan , Chua Lorna , Pizanias Michail , Samin Rashid , Young Trudi , Sagar Jayesh , Yorkmui Liu , Cirocchi Nicholas , Ahmed Safia , Barreda Sara Castillo , Kudchadkar Shantata , Baker Aleksandra , Jayasankar Balaji , Jackson James , Abdelsaid Kirolas , Hassan Mohamed , Shetty Shradda , Coldwell Chris , Davies Emma , Nader Helmy , Raistrick Maria , Ryska Ondrej , Hawkin Paul , Raymond Thomas , Witjes Caroline , Van de Steen Katrien , Crabtree Nicholas , Boyce Stephen , Somera Wilhelmina , Woodward Andrew , Ryan Karena , Kassai Miklos , Aleem Muhammad , Keogh-Bootland S , Ghosh Anil , Rixson Dani , Lewis Eleanor , Lynch Noel , Shovelton Charmaine , Zywicka Ewa , Guest Francesca , Barton Jess , Purnell Rebecca , Bamford Richard , Teare Thomas , Adams Benita , Chmielewski Gaspard , Smith Laura , Connolly Lewis , Niblett Rachel , Singh Amal , Halliwell Gail , Paraoan Marius , Doree Nicholas , Asaad Peter , Kilbride Claire , Carpenter Holly , Wilson Jeremy , Fletcher Juliette , Vijayagopal Kesav Aditya , Abbakar Malaz , Zaimis Tilemachos , Walsh Adam , Kubisz-Pudelko Agnieszka , Nono Jolanta , Pippard Lucy , Chowdhary Manish , Dalton Richard , Moussa Tamer , Dominguez Fabiana , Solla Gonzalo , Curbelo Jacqueline , Laurini Marcelo , Viola Marcelo , Brito Noelia , Al-Alnsi Ahmed , Al-Naggar Hamza , Saryah Lamis , Al-Shehari Mohammed , Alsayadi Ramzi , Al-Hutheifi Roqia'A , Shream Sarah , Saeed Samerah , Spurring Eleanor Margaret 
Published: November 2023

Background

Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks.

Methods

The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned.

Results

A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31).

Conclusion

Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov).