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

I read with interest the EAGLE quality improvement study1, looking at an international educational intervention to reduce anastomotic leak following right colectomy. The scale of the intervention was impressive, with significant enrolment, data collection, and analysis.  

I note that the overall data for the primary outcome is not statistically significant, but that the subgroup analysis “proportion of surgeons completing the module” appeared to be a significant piece of data. As you acknowledge, these subgroup analyses are exploratory and are to be interpreted with caution, particularly as they represent a relatively low percentage of study participants.

Given the overall non-statistically significant data and the reservations about interpretation of the subgroup analysis, I was concerned about the conclusion of the abstract that “completion of globally available digital training by engaged teams can alter anastomotic leak rates,” as I feel it misrepresents the findings of the study. Whilst an interesting area of research with potential for future findings, I feel the abstract should better represent the data outlined in this particular study.

I look forward to seeing the findings of EAGLE-2 and any further qualitative findings.