The Association Between Familiarity of the Surgeon-Anesthesiologist Dyad and Post-Operative Patient Outcomes for Complex Gastro- intestinal Cancer Surgery: A Population-Based Study

INTRODUCTION: The surgeon-anesthesiologist teamwork and relationship is crucial to good patient outcomes. Familiarity amongst work team members is associated with enhanced success in multiple fields, but rarely studied in the operating room. We examined the association between surgeon- anesthesiologist dyad familiarity – as the number of times working together – with short-term post-operative outcomes for complex gastrointestinal cancer surgery.

METHODS: We conducted a population-based retrospective cohort study of adults undergoing esophagectomy, pancreatectomy, and hepatectomy for cancer over 2007-2018. The exposure was the surgeon-anesthesiologist dyad familiarity captured as the annual volume of procedures of interest done by the dyad in the 4 years before the index surgery. The outcome was 90- day major morbidity (any Clavien-Dindo grade 3-5). The association between exposure and outcome was examined using multivariable logistic regression.

RESULTS: 7,893 patients cared for by 737 anesthesiologists and 163 surgeons were included. The median surgeon-anesthesiologist dyad volume was 1 (range: 0-12.2) procedures/year. 90-day major morbidity occurred in 43.0% of patients. There was a linear relationship between dyad volume and 90-day major morbidity (p=0.01). After adjustment, the annual dyad volume was independently associated with lower odds of 90-day major morbidity, with odds ratio 0.95 (95%CI 0.92-0.98; p=0.01) for each incremental procedure/ year/dyad. The results did not change when examining 30-day major morbidity.

CONCLUSIONS: 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%. This suggests that increasing the familiarity of surgeon-anesthesiologist dyads, or the number of procedures they do together, represents an opportunity to improve patient outcomes for complex gastrointestinal cancer surgery. 

Authors: Julie Hallet, MD MSc FRCSC FSSO, Associate Professor - University of Toronto (Presenter;Submitter;Author); Rinku Sutradhar, PhD, Professor - University of Toronto (Author); Angela Jerath, MD PhD, Associate Professor - University of Toronto (Author); Pablo Perez d’Empaire, MD, Assistant Professor - University of Toronto (Author); Francois Carrier, MD MSc, Anesthesiologist - CHUM (Author); Alexis Turgeon, MD MSc, Anesthesiologist - CHU de québec (Author); Daniel McIsaac, MD MPH, Anesthesiologist - The ottawa hospital (Author); Chris Idestrup, MD MSc, Anesthesiologist - University of Toronto (Author); Gianni Lorello, MD MSc, Anesthesiologist - University of Toronto (Author); Alana Flexman, MD, Anesthesiologist - UBC (Author); Biniam Kidane, MD MSc, Surgeon - University of Manitoba (Author); Wing Chan, MPH, Analyst- IC/ES (Author); Yosuf Kaliwal, MPH, analyst - ICES (Author); Victoria Barabash, MSc, Research coordinator - Sunnybrook research institute (Author); Natalie Coburn, MD MPH, Professor - University of Toronto (Author); Antoine Eskander, MD ScM, Assistant Professor - University of Toronto (Author)