Hallet Julie, Jerath Angela, d'Empaire Pablo Perez, Carrier François, Turgeon Alexis F, McIsaac Daniel I, Idestrup Chris, Lorello Gianni, Flexman Alana, Kidane Biniam, Chan Wing C, Gombay Anna, Coburn Natalie, Eskander Antoine, Sutradhar Rinku
Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Division of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
JAMA Surg. 2025 May 28. doi: 10.1001/jamasurg.2025.1386.
The surgeon-anesthesiologist teamwork is a core component of performance in the operating room, which can influence patient outcomes.
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.
Dyad familiarity, as the annual volume of procedures done by the surgeon-anesthesiologist dyad in 4 years prior to index surgery.
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.
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.
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.
外科医生与麻醉医生的团队合作是手术室工作表现的核心组成部分，会影响患者的治疗结果。
研究外科医生与麻醉医生二元组的熟悉程度（以二元组手术量，即共同完成的手术数量来衡量）与高危择期手术90天术后严重并发症之间的关联。
设计、设置和参与者：这项基于人群的回顾性队列研究使用了来自加拿大安大略省的行政医疗保健数据。参与者包括2009年至2019年期间的高危择期手术（心脏、低危和高危胃肠道[GI]、泌尿生殖系统、妇科肿瘤、神经外科、骨科、脊柱、血管以及头颈手术）。数据于2009年1月至2020年3月进行分析。
二元组熟悉程度，即索引手术前4年外科医生与麻醉医生二元组每年完成的手术量。
90天严重并发症（任何Clavien-Dindo分级3至5级）。使用多变量逻辑回归分析暴露因素与结局之间的关联，并按手术类型进行分层。
在711,006例索引手术中，二元组手术量中位数和90天严重并发症发生率因手术类型而异。心脏、骨科和肺部手术的二元组手术量中位数较高且二元组一致性较高。对于其他手术，二元组手术量中位数较低（每个二元组每年3例或更少手术）。在调整了医院环境、医院、外科医生和麻醉医生手术量以及患者年龄、性别和合并症负担后，观察到二元组手术量与高危胃肠道手术（比值比[OR]，0.92；95%置信区间[CI]，0.88 - 0.96）、低危胃肠道手术（OR，0.96；95% CI，0.95 - 0.98）、妇科肿瘤手术（OR，0.97；95% CI，0.94 - 0.99）和脊柱手术（OR，0.97；95% CI，0.96 - 0.99）的90天严重并发症之间存在独立关联。调整后的关联在其他类型手术中不显著。
在本研究中，外科医生与麻醉医生二元组熟悉程度的提高与接受低危和高危胃肠道手术、妇科肿瘤手术及脊柱手术患者的术后结局改善相关。对于每增加一次特定外科医生与麻醉医生二元组共同工作，低危胃肠道手术90天严重并发症的几率降低4%，高危胃肠道手术降低8%，妇科肿瘤手术降低3%，脊柱手术降低3%。需要进一步研究以确定利用外科医生与麻醉医生熟悉程度的益处来潜在改善患者结局的最有效护理结构。
