Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine.

Post-operative AF was associated with poorer long-term survival following oesophagectomy in this cohort. Further research should evaluate the influence of AF on cardiovascular and oncological outcomes following oesophagectomy.

Background: Oesophagectomy for locally advanced cancer carries high rates of morbidity and mortality. Patients require a thorough risk assessment alongside preoperative counselling. Total psoas area (TPA) measurements have been used as a surrogate marker of sarcopenia to predict post-operative complications in oesophageal cancer patients. No studies to date have determined whether there is an association between the proportion of TPA lost during neoadjuvant therapy and post-operative outcomes. Methods: Clinical data and imaging of patients who underwent neoadjuvant therapy followed by open two-stage oesophagectomy between January 2008 and April 2018 were analysed retrospectively. Patients who did not undergo restaging computed tomography scan prior to surgery were excluded from the study. The TPA was measured on two crosssectional slices at L4 on computed tomography scans pre-and post-neoadjuvant therapy. Results: A total of 53 patients who met inclusion criteria were identified. The mean loss of TPA was 7.3%. Patients who had a decrease of TPA of more than 4% had significantly increased 30-day mortality compared to those who lost 4% or less (24% versus 0%, P = 0.02). Patients aged over 65 years who also had a loss of TPA >4% had significantly increased 30-day mortality (37% versus 2.9%, odds ratio 19, P = 0.008). Conclusion: A decrease in TPA of >4% is associated with a significantly higher risk of post-operative mortality in patients undergoing neoadjuvant therapy followed by oesophagectomy. Measuring the loss of TPA during neoadjuvant treatment could be a novel aid to preoperative risk assessment.

A previously published study regarding the outcomes of oesophagectomy at a provincial hospital identified issues with perioperative care (Al-Herz et al 2012). The aim of this study was to evaluate the effect of changes in management at the institution concerned. This was a cohort study which compared the outcomes of 30 patients undergoing oesophagectomy before the unit audit and 30 patients after it. Demographics, operative details, recovery parameters, and oncological data were collected retrospectively. There was a significant reduction in the use of intravenous fluid, both intraoperatively (6.6 vs 3.3L, P < 0.0001) and during the first 24 hours (9.2 vs 5.5L, P < 0.0001). Patients were extubated three days earlier (P < 0.001) after the audit, and the percentage of patients requiring tracheostomy was smaller (26.7% vs 0%, P = 0.003). The length of total hospital stay was shorter (15 vs 13 days, P = 0.035). We conclude that the publication of a unit audit changed perioperative practice and resulted in a significant improvement in the short term outcomes after oesophagectomy.