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

被引:26
|
作者
Hallet, Julie [1 ,2 ,3 ,4 ,20 ]
Sutradhar, Rinku [4 ,5 ]
Jerath, Angela [3 ,4 ,6 ,7 ]
d'Empaire, Pablo Perez [6 ,7 ]
Carrier, Francois M. [8 ,9 ]
Turgeon, Alexis F. [10 ,11 ,12 ]
McIsaac, Daniel I. [13 ,14 ]
Idestrup, Chris [6 ,7 ]
Lorello, Gianni [7 ,15 ,16 ]
Flexman, Alana [17 ,18 ,19 ]
Kidane, Biniam [19 ]
Kaliwal, Yosuf [4 ]
Chan, Wing C. [4 ]
Barabash, Victoria [3 ]
Coburn, Natalie [1 ,2 ,3 ,4 ]
Eskander, Antoine [2 ,3 ,4 ,19 ]
机构
[1] Univ Toronto, Dept Surg, Toronto, ON, Canada
[2] Sunnybrook Hlth Sci Ctr, Div Surg Oncol, Odette Canc Ctr, Toronto, ON, Canada
[3] Sunnybrook Res Inst, Clin Evaluat Sci, Toronto, ON, Canada
[4] ICES, Toronto, ON, Canada
[5] Univ Toronto, Dalla Lana Sch Publ Hlth, Div Biostat, Toronto, ON, Canada
[6] Sunnybrook Hlth Sci Ctr, Dept Anesthesiol, Toronto, ON, Canada
[7] Univ Toronto, Dept Anesthesiol & Pain Med, Toronto, ON, Canada
[8] Univ Montreal, Dept Anesthesiol & Pain Med, Montreal, PQ, Canada
[9] Univ Laval, Div Crit Care Med, Dept Anesthesiol & Crit Care Med, Quebec City, PQ, Canada
[10] Univ Laval, Populat Hlth & Optimal Hlth Practices Res Unit, CHU Quebec Univ Laval Res Ctr, Trauma Emergency Crit Care Med, Quebec City, PQ, Canada
[11] Univ Ottawa, Ottawa Hosp, Dept Anesthesiol, Ottawa, ON, Canada
[12] Univ Ottawa, Ottawa Hosp, Dept Pain Med, Ottawa, ON, Canada
[13] Univ Hlth Network, Toronto Western Hosp, Dept Anesthesiol, Toronto, ON, Canada
[14] Univ Hlth Network, TorontoWestern Hosp, Wilson Ctr, Toronto, ON, Canada
[15] Womens Coll Hosp, Womens Coll Res Inst, Toronto, ON, Canada
[16] Univ British Columbia, Dept Anesthesiol Pharmacol & Therapeut, Vancouver, BC, Canada
[17] Univ Manitoba, Sect Thorac Surg, Dept Surg, Winnipeg, MB, Canada
[18] Univ Manitoba, Dept Community Hlth Sci, Winnipeg, MB, Canada
[19] St Pauls Hosp, Providence Hlth Care, Dept Anesthesiol, Vancouver, BC, Canada
[20] Sunnybrook Hlth Sci Ctr, 2075 Bayview Ave, Toronto, ON M4N3M5, Canada
关键词
TRANSACTIVE MEMORY; OPERATING-ROOM; NONTECHNICAL SKILLS; 30-DAY MORTALITY; SURGICAL-TEAMS; MENTAL MODELS; IMPACT; COMPLICATIONS; PERFORMANCE; EXPERIENCE;
D O I
10.1001/jamasurg.2022.8228
中图分类号
R61 [外科手术学];
学科分类号
摘要
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.
引用
收藏
页码:465 / 473
页数:9
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