Familiarity of the surgeon-anesthesiologist dyad and major morbidity after high-risk elective surgery

Importance — The surgeon-anesthesiologist teamwork is a core component of performance in the operating room, which can influence patient outcomes.

Objective — To examine the association between surgeon-anesthesiologist dyad familiarity (as dyad volume, the number of procedures done together) with 90-day postoperative major morbidity for high-risk elective surgery.

Design, setting, and participants — This population-based retrospective cohort study used administrative health care data from Ontario, Canada. Participants included high-risk elective operations (cardiac, low- and high- risk gastrointestinal [GI], genitourinary, gynecology oncology, neurosurgery, orthopedic, spine, vascular, and head and neck) from 2009 through 2019. Data were analyzed from January 2009 to March 2020.

Exposure — Dyad familiarity, as the annual volume of procedures done by the surgeon-anesthesiologist dyad in 4 years prior to index surgery.

Main outcomes and measures — 90-day major morbidity (any Clavien-Dindo grade 3 to 5). The association between exposure and outcome was examined using multivariable logistic regression, stratified by type of procedure.

Results — Among 711 006 index procedures, the median dyad volume and rate of 90-day major morbidity varied by type of procedure. There was higher median volume and dyad consistency for cardiac, orthopedic, and lung surgery. For other procedures, the median dyad volume was low (3 or less procedures per dyad per year). An independent association was observed between dyad volume and 90-day major morbidity for high-risk GI surgery (odds ratio [OR], 0.92; 95% CI, 0.88-0.96), low-risk GI surgery (OR, 0.96; 95% CI, 0.95-0.98), gynecology oncology surgery (OR, 0.97; 95% CI, 0.94-0.99), and spine surgery (OR, 0.97; 95% CI, 0.96-0.99), after adjusting for hospital setting, hospital, surgeon and anesthesiologist volume, and patient age, sex, and comorbidity burden. The adjusted associations were not significant for other types of procedures.

Conclusions and relevance — In this study, increasing familiarity of the surgeon-anesthesiologist dyad was associated with improved postoperative outcomes for patients undergoing low- and high-risk GI surgery, gynecology oncology surgery, and spine surgery. For each additional time that a unique surgeon-anesthesiologist dyad worked together, the odds of 90-day major morbidity decreased by 4% for low-risk GI surgery, 8% for high-risk GI surgery, 3% for gynecology oncology surgery, and 3% for spine surgery. Additional research is needed to determine the most effective care structures that harness the benefits of surgeon-anesthesiologist familiarity to potentially improve patient outcomes.