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Multicenter Study
. 2024 Dec;17(12):e011065.
doi: 10.1161/CIRCOUTCOMES.124.011065. Epub 2024 Dec 9.

Multicenter Analysis of the Relationship Between Operative Team Familiarity and Safety and Efficiency Outcomes in Cardiac Surgery

Tyler M Bauer  1 , Allison M Janda  2 , Xiaoting Wu  1 , Carol Ling  1 , Douglas C Shook  3 , Gabriela Querejeta-Roca  3 , Kenneth G Shann  4 , Trevor Smith  5 , Michael R Mathis  2 , Tsuyoshi Kaneko  6 , Thoralf M Sundt 3rd  4 , Robert B Schonberger  7 , Steven D Harrington  8 , Roger D Dias  9 , Francis D Pagani  1 , Donald S Likosky  1 , Steven Yule  10   11 ; VARSITY Surgery Investigators
Collaborators, Affiliations
Multicenter Study

Multicenter Analysis of the Relationship Between Operative Team Familiarity and Safety and Efficiency Outcomes in Cardiac Surgery

Tyler M Bauer et al. Circ Cardiovasc Qual Outcomes. 2024 Dec.

Abstract

Background: Safety in cardiac surgical procedures is predicated on effective team dynamics. This study associated operative team familiarity (ie, the extent of clinical collaboration among surgical team members) with procedural efficiency and Society of Thoracic Surgeons (STS) adjudicated patient outcomes.

Methods: Institutional STS adult cardiac surgery registry and electronic health record data from 2014 to 2021 were evaluated across 3 quaternary hospitals. Team familiarity was defined as the mean number of cardiac operations performed by surgeon-anesthesiologist, surgeon-perfusionist, and anesthesiologist-perfusionist dyads within 1 year of the operation. The primary outcomes were (1) safety, measured by the STS' composite major morbidity and operative mortality measure, and (2) procedural efficiency, assessed by cardiopulmonary bypass duration. Team familiarity was stratified by terciles (low, moderate, and high) for crude analyses and analyzed continuously for adjusted analyses. Multivariable logistic and linear regression models were used to assess the association between team familiarity and outcomes.

Results: Team familiarity was calculated for 13 581 operations. The median (interquartile range) patient age was 64 (55-72) years, and 31.9% (4328/13 581) were women. Terciles of team familiarity were defined as low (<6.00 average shared operations), moderate (6.00-9.67), and high (>9.67). Teams in lower terciles had higher observed STS morbidity and mortality rates (low, 17.9%; moderate, 18.0%; high, 16.0%; P=0.02) and longer median cardiopulmonary bypass duration (low, 137 minutes; moderate, 131 minutes; high, 118 minutes; P<0.001). After risk adjustment, team familiarity was not significantly associated with STS morbidity and mortality (estimate, -0.001 [95% CI, -0.998 to 0.997]) but was inversely associated with cardiopulmonary bypass duration (estimate, -2.02 minutes per 1 unit increase in team familiarity [95% CI, -2.30 to -1.75]).

Conclusions: Increased team familiarity was not associated with STS morbidity and mortality but was inversely correlated with cardiopulmonary bypass duration, demonstrating potential benefit. Interventions aimed at improving team familiarity among operative teams may increase procedural efficiency.

Keywords: adult; cardiopulmonary bypass; hospitals; linear models; morbidity.

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Conflict of interest statement

Dr Janda received a research grant from the US National Institutes of Health (NHLBI) and research support paid to the University of Michigan from Becton, Dickinson and Company, Bio Intellisense, Inc, and Hiasco-USA Pharmaceuticals, Inc, unrelated to this present work. Dr Shook is a speaker and consultant for Baylis and Edwards. Dr Kaneko is a consultant for Edwards Lifesciences and Medtronic. Dr Mathis has received research grants from the US National Institutes of Health (NHLBI, National Institute of Diabetes and Digestive and Kidney Diseases ) and research support paid to the University of Michigan from Chiesi, USA, unrelated to this present work. Dr Likosky receives partial salary support through Blue Cross Blue Shield, is a consultant to the American Society of ExtraCorporeal Technology, and receives funding from the Agency for Healthcare Research and Quality and the National Institutes of Health. Dr Yule is a past member of the advisory board for General Education Council, Johnson and Johnson Institute. Dr Pagani is a noncompensated ad hoc scientific advisor for Abbott, CH Biomedical, FineHeart, and Medtronic; 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 Schonberger reports that he owns stock in Johnson and Johnson, unrelated to the present article, and that his institution has received research funds from Merck, Inc, for a study in which he was involved, unrelated to the present article. The other authors report no conflicts.

Figures

Figure 1.
Figure 1.
Histogram of team familiarity between surgeons, perfusionists, and anesthesiologists.
Figure 2.
Figure 2.
The interaction between cardiopulmonary bypass time and team familiarity. A, Acuity of procedure. B, Society of Thoracic Surgeons (STS) predicted risk of mortality (PROM). Shaded regions represent the 95% CI. STS MM indicates Society of Thoracic Surgeons’ composite major morbidity and operative mortality.
See this image and copyright information in PMC

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