Background

anastomotic leak, colorectal surgery
ANASTOMOTIC LEAK, COMPLICATION
Improvement of surgical safety is a global healthcare priority with significant potential to reduce morbidity and mortality. The most important complication of colorectal surgery is anastomotic leak [Previous research has shown that specific risk factors that may be identified pre- and intra-operatively increase the risk of anastomotic leak after right colectomy, and variation in surgical practice can harm patient outcomes [Large-scale quality improvement interventions generate a multitude of challenges that demand a robust study design and the ability for the design to adapt for delivery in different environments and social contexts. The EAGLE trial adopted an innovative batched stepped wedge design aimed at achieving good uptake and statistical efficiency. In this paper, we expand on the features of this design and reflect on lessons learned about the implementation of randomised evaluations of quality improvement programmes on an international scale.