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. 2023 May 1;158(5):465-473.
doi: 10.1001/jamasurg.2022.8228.

Association Between Familiarity of the Surgeon-Anesthesiologist Dyad and Postoperative Patient Outcomes for Complex Gastrointestinal Cancer Surgery

Julie Hallet  1   2   3   4 , Rinku Sutradhar  4   5 , Angela Jerath  3   4   6   7 , Pablo Perez d'Empaire  6   7 , François M Carrier  8   9 , Alexis F Turgeon  10   11 , Daniel I McIsaac  12 , Chris Idestrup  6   7 , Gianni Lorello  7   13   14 , Alana Flexman  15   16 , Biniam Kidane  16 , Yosuf Kaliwal  4 , Wing C Chan  4 , Victoria Barabash  3 , Natalie Coburn  1   2   3   4 , Antoine Eskander  2   3   4   16
Affiliations

Association Between Familiarity of the Surgeon-Anesthesiologist Dyad and Postoperative Patient Outcomes for Complex Gastrointestinal Cancer Surgery

Julie Hallet et al. JAMA Surg. .

Erratum in

  • Errors in Author Names and Affiliation.
    [No authors listed] [No authors listed] JAMA Surg. 2023 May 1;158(5):563. doi: 10.1001/jamasurg.2023.0958. JAMA Surg. 2023. PMID: 37017981 Free PMC article. No abstract available.

Abstract

Importance: The surgeon-anesthesiologist teamwork and relationship is crucial to good patient outcomes. Familiarity among work team members is associated with enhanced success in multiple fields but rarely studied in the operating room.

Objective: To examine the association between surgeon-anesthesiologist dyad familiarity-as the number of times working together-with short-term postoperative outcomes for complex gastrointestinal cancer surgery.

Design, setting, and participants: This population-based retrospective cohort study based in Ontario, Canada, included adults undergoing esophagectomy, pancreatectomy, and hepatectomy for cancer from 2007 through 2018. The data were analyzed January 1, 2007, through December 21, 2018.

Exposures: Dyad familiarity captured as the annual volume of procedures of interest done by the surgeon-anesthesiologist dyad in the 4 years before the index surgery.

Main outcomes and measures: Ninety-day major morbidity (any Clavien-Dindo grade 3 to 5). The association between exposure and outcome was examined using multivariable logistic regression.

Results: Seven thousand eight hundred ninety-three patients with a median age of 65 years (66.3% men) were included. They were cared for by 737 anesthesiologists and 163 surgeons who were also included. The median surgeon-anesthesiologist dyad volume was 1 (range, 0-12.2) procedures per year. Ninety-day major morbidity occurred in 43.0% of patients. There was a linear association between dyad volume and 90-day major morbidity. After adjustment, the annual dyad volume was independently associated with lower odds of 90-day major morbidity, with an odds ratio of 0.95 (95% CI, 0.92-0.98; P = .01) for each incremental procedure per year, per dyad. The results did not change when examining 30-day major morbidity.

Conclusions and relevance: Among adults undergoing complex gastrointestinal cancer surgery, increasing familiarity of the surgeon-anesthesiologist dyad was associated with improved short-term patient outcomes. For each additional time that a unique surgeon-anesthesiologist dyad worked together, the odds of 90-day major morbidity decreased by 5%. These findings support organizing perioperative care to increase the familiarity of surgeon-anesthesiologist dyads.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Hallet reported speaking fees from Ipsen Advanced Accelerator Applications and Medtronic outside the submitted work. Dr Jerath reported grants from the Alternate Funding Plan outside the submitted work and received a merit award for research activities from the Department of Anesthesiology and Pain Medicine, University of Toronto. Dr Carrier reported receiving the Fonds de recherche du Québec Career award during the conduct of the study and grants from Canadian Institutes of Health Research and Chaire de médecine transfusionnelle Fondation-Héma-Québec-Bayer de l’Université de Montréal outside the submitted work. Dr Turgeon reported that they are the Canada research chair in Critical Care Neurology and Trauma. Dr Flexman reported grants from Michael Smith Research BC Foundation Health Professional during the conduct of the study and consultant fees from UpToDate outside the submitted work. Dr Kaliwal reported that they were an employed analyst with ICES for this project during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Distribution of Annualized Dyad Volume (N = 7893)
Figure 2.
Figure 2.. Linear Association of the Probability of 90-Day Major Morbidity by Annualized Dyad Volume, Unadjusted and Adjusteda
Shaded areas represent 95% CIs. aAdjusted for hospital setting, hospital annual volume, surgeon annual volume, and patient age, sex, and comorbidities.
See this image and copyright information in PMC

Comment in

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