- Design
- International prospective cohort study
- Population
- 2875 adults having right colectomy with anastomosis, 332 hospitals, 60 countries
- Primary outcome
- 30-day anastomotic leak or intra-abdominal collection
- Effect
- 9.1% vs 16.4%; adjusted OR 0.56 (95% CI 0.41 to 0.78)
EAGLE-2 was an international prospective cohort of 2875 consecutive right colectomies with primary anastomosis, across 332 hospitals in 60 countries in mid-2024. The EAGLE digital safe-anastomosis training was made open access, and operations were grouped by whether the surgeon had completed it.
Leak or collection occurred in 9.1% of operations by trained surgeons against 16.4% by untrained ones. After adjusting for ASA grade, urgency and contamination, training was associated with an adjusted OR of 0.56 (95% CI 0.41 to 0.78), with lower reoperation and readmission.
This follows the EAGLE randomised trial, so the direction is plausible. But surgeons who choose to take a course may differ in other ways. The cost is an hour or two of a trainee's time, which makes it an easy addition to any unit's induction.
- Add the EAGLE modules to induction for registrars doing right colectomy.
- Adopt the recommended anastomosis checklist in theatre.
- Audit your unit's right colectomy leak rate against the 5–10% benchmark.
- Track leak and collection together, as EAGLE-2 did.
Why it matters
A leak rate may be as much about what the surgeon was taught as about the stapler or the patient.
Don't overread it
This was observational; surgeons self-selected into training, so part of the difference may reflect who trains rather than what training does.
The statistics, in plain English
An adjusted odds ratio of 0.56 means about 44% lower odds of leak with training, after accounting for the measured differences. Unmeasured ones — experience, volume, conscientiousness — cannot be adjusted away in a cohort.
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