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. 2024 May 1;279(5):891-899.
doi: 10.1097/SLA.0000000000006100. Epub 2023 Sep 27.

Evaluating the Impact of Operative Team Familiarity on Cardiac Surgery Outcomes: A Retrospective Cohort Study of Medicare Beneficiaries

Jake A Awtry  1   2 , James H Abernathy  3 , Xiaoting Wu  4 , Jie Yang  4 , Min Zhang  5 , Hechuan Hou  4 , Tsuyoshi Kaneko  6 , Kim I de la Cruz  1 , Korana Stakich-Alpirez  4 , Steven Yule  7 , Joseph C Cleveland Jr  8 , Douglas C Shook  9 , Michael G Fitzsimons  10 , Steven D Harrington  11 , Francis D Pagani  12 , Donald S Likosky  4 ; Video Assessment of caRdiac Surgery qualITY (VARSITY) Surgery Investigators
Affiliations

Evaluating the Impact of Operative Team Familiarity on Cardiac Surgery Outcomes: A Retrospective Cohort Study of Medicare Beneficiaries

Jake A Awtry et al. Ann Surg. .

Abstract

Objective: To associate surgeon-anesthesiologist team familiarity (TF) with cardiac surgery outcomes.

Background: TF, a measure of repeated team member collaborations, has been associated with improved operative efficiency; however, examination of its relationship to clinical outcomes has been limited.

Methods: This retrospective cohort study included Medicare beneficiaries undergoing coronary artery bypass grafting (CABG), surgical aortic valve replacement (SAVR), or both (CABG+SAVR) between January 1, 2017, and September 30, 2018. TF was defined as the number of shared procedures between the cardiac surgeon and anesthesiologist within 6 months of each operation. Primary outcomes were 30- and 90-day mortality, composite morbidity, and 30-day mortality or composite morbidity, assessed before and after risk adjustment using multivariable logistic regression.

Results: The cohort included 113,020 patients (84,397 CABG; 15,939 SAVR; 12,684 CABG+SAVR). Surgeon-anesthesiologist dyads in the highest [31631 patients, TF median (interquartile range)=8 (6, 11)] and lowest [44,307 patients, TF=0 (0, 1)] TF terciles were termed familiar and unfamiliar, respectively. The rates of observed outcomes were lower among familiar versus unfamiliar teams: 30-day mortality (2.8% vs 3.1%, P =0.001), 90-day mortality (4.2% vs 4.5%, P =0.023), composite morbidity (57.4% vs 60.6%, P <0.001), and 30-day mortality or composite morbidity (57.9% vs 61.1%, P <0.001). Familiar teams had lower overall risk-adjusted odds of 30-day mortality or composite morbidity [adjusted odds ratio (aOR) 0.894 (0.868, 0.922), P <0.001], and for SAVR significantly lower 30-day mortality [aOR 0.724 (0.547, 0.959), P =0.024], 90-day mortality [aOR 0.779 (0.620, 0.978), P =0.031], and 30-day mortality or composite morbidity [aOR 0.856 (0.791, 0.927), P <0.001].

Conclusions: Given its relationship with improved 30-day cardiac surgical outcomes, increasing TF should be considered among strategies to advance patient outcomes.

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Conflict of interest statement

Dr J.H.A. receives funding from the Agency for Healthcare Research and Quality; is a member of the Society of Cardiovascular Anesthesiologists Board of Directors; serves on the advisory board for Intelliport. Dr T.K. is a consultant receiving advisor, speaking, or lecture fees from Edwards Lifesciences Corporation, Abbott Laboratories, and Medtronic Inc. Dr K.I.d.l.C. is a consultant receiving advisor, speaking, or lecture fees from Edwards Lifesciences Corporation and Terumo Aortic. Dr S.Y. receives consulting fees from Johnson & Johnson Institute. Dr J.C.C. is a consultant for Abbott Laboratories and Edwards Lifesciences. Dr D.C.S. is a consultant receiving consulting and speaking fees from Edwards Lifesciences. Dr F.D.P. is a noncompensated ad-hoc scientific advisor for Abbott, CH Biomedical, FineHeart, and Medtronic; noncompensated medical monitor for Abiomed; Member, Data Safety Monitoring Board for Carmat and the National Heart, Lung, and Blood Institute PumpKIN Study; receives grant funding from the National Heart, Lung, and Blood Institute and the Agency for Healthcare Research and Quality; and receives partial salary support from Blue Cross/Blue Shield of Michigan as Associate Director of the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative. Dr D.S.L. has received a research grant from the National Institutes of Health (NHLBI R01HL146619). Outside of this work, Dr D.S.L.: (1) received research funding from the Agency for Healthcare Research and Quality, and the National Institutes of Health; (2) served as a consultant for the American Society of Extracorporeal Technology; and (3) received partial salary support from Blue Cross Blue Shield of Michigan to advance quality in Michigan in conjunction with the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative. Dr X.W. and Dr J.Y. had full access to all the data in the study and assume responsibility for the integrity of the data and the accuracy of the data analysis. The remaining authors report no conflicts of interest.

Figures

Figure 1:
Figure 1:. Schematic of Team Familiarity Calculation and Analysis.
Approach for calculating Team Familiarity (TF) prior to comparing outcomes. The primary surgeon and anesthesiologist for each case were identified via the algorithms depicted in Supplemental Figure 1. For the primary analysis TF equaled the number of shared surgeries between the surgeon and anesthesiologist in the six months preceding each case in the cohort.
Figure 2:
Figure 2:. Increasing Surgeon-Anesthesiologist Team Familiarity and Adjusted Relative Odds of 30-Day Mortality or Composite Morbidity.
Relationship between increasing values of team familiarity (x-axis) and the adjusted odds ratio (aOR) for 30-day mortality or morbidity (y-axis). Shaded area represents the 95% confidence interval for the aOR.
See this image and copyright information in PMC

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