Department of Anesthesiology, Michigan Medicine, University of Michigan, Ann Arbor, MI. Electronic address: https://twitter.com/Michael_Mathis.
Department of Clinical Surgery, University of Edinburgh, Scotland; Department of Surgery, Brigham & Women's Hospital/Harvard Medical School, Boston, MA. Electronic address: https://twitter.com/NOTSS_lab.
Surgery. 2021 Oct;170(4):1031-1038. doi: 10.1016/j.surg.2021.05.020. Epub 2021 Jun 17.
Familiarity among cardiac surgery team members may be an important contributor to better outcomes and thus serve as a target for enhancing outcomes.
Adult cardiac surgical procedures (n = 4,445) involving intraoperative providers were evaluated at a tertiary hospital between 2016 and 2020. Team familiarity (mean of prior cardiac surgeries performed by participating surgeon/nonsurgeon pairs within 2 years before the operation) were regressed on cardiopulmonary bypass duration (primary-an intraoperative measure of care efficiency) and postoperative complication outcomes (major morbidity, mortality), adjusting for provider experience, surgeon 2-year case volume before the surgery, case start time, weekday, and perioperative risk factors. The relationship between team familiarity and outcomes was assessed across predicted risk strata.
Median (interquartile range) cardiopulmonary bypass duration was 132 (91-192) minutes, and 698 (15.7%) patients developed major postoperative morbidity. The relationship between team familiarity and cardiopulmonary bypass duration significantly differed across predicted risk strata (P = .0001). High (relative to low) team familiarity was associated with reduced cardiopulmonary bypass duration for medium-risk (-24 minutes) and high-risk (-27 minutes) patients. Increasing team familiarity was not significantly associated with the odds of major morbidity and mortality.
Team familiarity, which was predictive of improved intraoperative efficiency without compromising major postoperative outcomes, may serve as a novel quality improvement target in the setting of cardiac surgery.
心脏手术团队成员之间的熟悉程度可能是改善手术结果的重要因素，因此可以作为提高手术效果的目标。
在 2016 年至 2020 年期间，对一家三级医院进行的涉及术中提供者的成人心脏手术程序（n=4445）进行了评估。团队熟悉程度（参与手术的外科医生/非外科医生在手术前 2 年内进行的先前心脏手术的平均值）与体外循环持续时间（术中护理效率的衡量标准）和术后并发症结果（主要发病率、死亡率）相关，调整了提供者经验、手术医生在手术前 2 年内的病例量、手术开始时间、星期几和围手术期风险因素。评估了团队熟悉程度与结果之间的关系在预测风险分层中的关系。
体外循环持续时间中位数（四分位距）为 132（91-192）分钟，698（15.7%）名患者出现主要术后并发症。团队熟悉程度与体外循环持续时间之间的关系在预测风险分层中显著不同（P=0.0001）。高（相对于低）团队熟悉度与中危（-24 分钟）和高危（-27 分钟）患者的体外循环持续时间缩短相关。增加团队熟悉度与主要发病率和死亡率的几率无关。
团队熟悉度可以预测术中效率的提高，而不会影响主要术后结果，因此可以作为心脏手术中一种新的质量改进目标。
