Bauer Tyler M, Janda Allison M, Wu Xiaoting, Ling Carol, Shook Douglas C, Querejeta-Roca Gabriela, Shann Kenneth G, Smith Trevor, Mathis Michael R, Kaneko Tsuyoshi, Sundt Thoralf M, Schonberger Robert B, Harrington Steven D, Dias Roger D, Pagani Francis D, Likosky Donald S, Yule Steven
Department of Cardiac Surgery (T.M.B., X.W., C.L., F.D.P., D.S.L.), University of Michigan, Ann Arbor.
Department of Anesthesiology, Michigan Medicine (A.M.J., M.R.M.), University of Michigan, Ann Arbor.
Circ Cardiovasc Qual Outcomes. 2024 Dec;17(12):e011065. doi: 10.1161/CIRCOUTCOMES.124.011065. Epub 2024 Dec 9.
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.
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.
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%; =0.02) and longer median cardiopulmonary bypass duration (low, 137 minutes; moderate, 131 minutes; high, 118 minutes; <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]).
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.
心脏外科手术的安全性取决于有效的团队协作。本研究将手术团队的熟悉程度（即手术团队成员之间的临床协作程度）与手术效率以及美国胸外科医师协会（STS）判定的患者预后相关联。
对2014年至2021年期间3家四级医院的机构性STS成人心脏手术登记数据和电子健康记录数据进行评估。团队熟悉程度定义为手术前1年内外科医生与麻醉医生、外科医生与体外循环灌注师以及麻醉医生与体外循环灌注师配对完成的心脏手术平均数量。主要结局指标为：（1）安全性，通过STS的综合严重并发症和手术死亡率指标衡量；（2）手术效率，通过体外循环持续时间评估。团队熟悉程度按三分位数分层（低、中、高）进行粗分析，并进行连续分析以进行调整分析。使用多变量逻辑回归和线性回归模型评估团队熟悉程度与结局之间的关联。
计算了13581例手术的团队熟悉程度。患者年龄中位数（四分位间距）为64（55 - 72）岁，女性占31.9%（4328/13581）。团队熟悉程度的三分位数定义为低（平均共同手术次数<6.00）、中（6.00 - 9.67）和高（>9.67）。较低三分位数的团队观察到的STS并发症和死亡率更高（低，17.9%；中，18.0%；高，16.0%；P = 0.02），体外循环持续时间中位数更长（低，137分钟；中，131分钟；高，118分钟；P < 0.001）。风险调整后，团队熟悉程度与STS并发症和死亡率无显著关联（估计值，-0.001 [95%置信区间，-0.998至0.997]），但与体外循环持续时间呈负相关（估计值，团队熟悉程度每增加1个单位，体外循环持续时间减少2.02分钟[95%置信区间，-2.30至-1.75]）。
团队熟悉程度的提高与STS并发症和死亡率无关，但与体外循环持续时间呈负相关，显示出潜在益处。旨在提高手术团队之间熟悉程度的干预措施可能会提高手术效率。
