Author response to comment on: Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

BJS, https://doi.org/10.1093/bjs/znad370, published 29 November 2023

We thank Dr Piper for the interest in our paper1. This has been the first global RCT testing a complex behavioural change intervention in surgery and we are all learning as to how educational tools might best be used for patient benefit. This is the start of a journey – but a clear and statistically significant signal that higher surgeon engagement is directly translated into higher implementation of the interventions and a reduction in anastomotic leak after adjusted analysis cannot be ignored.

We acknowledge that the original trial was primarily not powered and aimed to investigate how the levels of surgeons’ engagement would affect results, and that is why we have launched EAGLE-2, a global cohort study of the EAGLE Safe Anastomosis intervention and the outcomes in right hemicolectomy patients after surgical teams have been using the EAGLE interventions. This snapshot study will rapidly report on the impact of the interventions in wider, real-world settings and we have already recruited more than 350 hospitals from 54 countries.  We look to a rapid turnaround to validate the findings in EAGLE-1.

RCTs are expensive and time-consuming. Signals in the data that are of clinical interest and may impact on patient outcomes would benefit from further study should be clearly identified, even for casual readers.

We look forward to updating the community very soon.