Surgical teams with more experience working together associated with fewer patient complications

Greater familiarity between the surgeon and anesthesiologist is associated with lower odds of postoperative complications after high-risk surgeries, according to a new study from a team of Canadian researchers.

The findings, which were recently published in JAMA Surgery, highlight the potential of using team design to improve patient outcomes.

“Team design is used in a lot of other fields like business and sports, but it’s overlooked in health care,” says lead author Julie Hallet, a scientist at Sunnybrook Research Institute and an associate professor of surgeryat the University of Toronto’s Temerty Faculty of Medicine.

“Health care is one of the only areas where we expect people who have never worked together — who sometime have never met before — to perform at peak levels in the most stressful circumstances.”

As a surgeon, Hallet knows firsthand how the environment in an operating room can change depending on how familiar team members are with each other. It’s something that she and her colleagues have all observed but until recently, lacked the data to describe.

To study this question, she and other researchers at ICES analyzed population-based health care data from 711,005 high-risk elective surgeries performed in Ontario between 2009 and 2019. These data allowed the researchers to identify the surgeon and anesthesiologist for each procedure and determine how often the pair had worked together in the previous four years, providing a measure of familiarity between the two.

They found that for surgeries related to the gastrointestinal tract, spine and gynecological cancers, there was an association between surgeon-anesthesiologist familiarity and the odds of severe complications in the 90 days after surgery. For each additional procedure performed by the same surgeon-anesthesiologist pair, the likelihood of experiencing a severe complication decreased by three to eight per cent.

“Those are meaningful differences because severe postoperative complications can lead to additional surgeries, ICU stays or even death,” says Hallet.

For these surgeries, each procedure done together previously matters.

The researchers also noted that for most procedures, the average surgeon-anesthesiologist pair were in the operating room together three times a year or less. The exceptions were cardiac and orthopedic surgery, where, on average, surgeons teamed up with the same anesthesiologist for nine or eight procedures each year, respectively.

These procedures had greater team stability because anesthesiologists require specialized training to participate in cardiac surgeries and orthopedic surgeries are often done at dedicated centres like Sunnybrook’s Holland Centre.   

“In those particular procedures where they’ve achieved team stability, we do not see an association because the team already has a high degree of familiarity,” says Hallet.

The findings show that unlike expensive new technologies or drugs, optimizing the makeup of surgical teams to foster consistency and familiarity could be a no-cost way to improve patient outcomes.

Hallet acknowledges that there are challenges and potential drawbacks to adopting a team design-centred approach to organizing and scheduling surgeries. One possible consequence could be that anesthesiologists — most of whom are currently considered generalists — become increasingly specialized and less comfortable stepping in to cover other procedures.

In the next phase of this project, the researchers are looking at this and other factors that can support the implementation of more stable teams in the operating room. They are interviewing anesthesiologists and surgeons to understand their perspectives about the different models of care and what concerns need to be addressed to enable adoption of this new approach. They are also doing a cost analysis to determine how much money hospitals and health systems could save by having more familiar surgical teams and fewer postoperative complications.

“You can’t put team stability or team familiarity in a bottle or replicate its effects through protocols or processes,” says Hallet.

“The only way that you can get that effect is by putting people together more often and having them work and succeed together.”

This study was funded by ICES and the Sunnybrook AFP Innovation Fund.