Key to Better Outcomes in Surgery?

TOPLINE:

Familiarity between surgeons and anesthesiologists was associated with improved outcomes in gastrointestinal, gynecologic oncologic, and spine surgeries, with each additional procedure performed together associated with reduced odds of 90-day postoperative major morbidity.

METHODOLOGY:

• Researchers conducted a retrospective cohort study using administrative healthcare data in Canada to assess the link between how often teams of surgeons and anesthesiologists worked together and outcomes for their patients.
• They included men and women aged 18 years or older who underwent high-risk elective surgeries with a postoperative stay over 24 hours from 2009 to 2019.
• Clinician familiarity was measured by case volume, defined as the average annual number of procedures performed by the same surgeon-anesthesiologist pair in the 4 years prior to the index operation.
• Procedures included cardiac, high- and low-risk GI, genitourinary, gynecologic oncologic, orthopedic, neurosurgery, spine, thoracic, vascular, and head and neck surgeries.
• The primary outcome was 90-day major morbidity.

TAKEAWAY:

• The analysis included 711,006 procedures. For most surgeries, the median dyad volume was three or fewer procedures per team per year, except for cardiac and orthopedic surgeries, which had median volumes of nine and eight procedures per group per year, respectively.
• Each additional procedure per year for the same surgeon-anesthesiologist pair was associated with a 4% reduction in the odds of 90-day morbidity for low-risk GI surgery (adjusted odds ratio [aOR], 0.96; 95% CI, 0.95-0.98) and an 8% reduction in the odds for high-risk GI surgery (aOR, 0.92; 95% CI, 0.88-0.96).
• For gynecologic oncologic and spine surgeries, each additional procedure performed per year by the same surgeon-anesthesiologist pair was associated with a 3% reduction in the odds of 90-day morbidity (aOR, 0.97; 95% CI, 0.94-0.99 and aOR, 0.97; 95% CI, 0.96-0.99, respectively). No significant association was found for other procedures.
• Dyad volume was also independently associated with 30-day major morbidity for high-risk (aOR, 0.90; 95% CI, 0.86-0.94) and low-risk (aOR, 0.96; 95% CI, 0.94-0.97) GI surgeries.

IN PRACTICE:

“These findings indicate that for each additional procedure performed by a specific surgeon-anesthesiologist dyad, there is a corresponding decrease in the likelihood of experiencing 90-day major morbidity. Each procedure done together matters,” the authors of the study wrote.

“Increasing the familiarity of surgeon-anesthesiologist dyads or the number of procedures they do together represents an opportunity to improve patient outcomes for GI, gynecology oncology, and spine surgery,” they added.

“These results make coordinated scheduling of consistent surgeon-anesthesiologist dyads (and nurse staffing) an attractive process measure for surgical quality improvement,” experts wrote in an commentary accompanying the journal article.

SOURCE:

The study was led by Julie Hallet, MD, MSc, of the Department of Surgery at the University of Toronto, Toronto, Ontario, Canada. It was published online on May 28, 2025, in JAMA Surgery.

LIMITATIONS:

The use of routinely collected health administrative data may have introduced the risk for misclassification and limited the details on factors affecting patient outcomes. Owing to the focus on surgeon-anesthesiologist dyads, the contributions from other team members, such as nurses, trainees, and assistants, were excluded. The analysis was limited to high-risk and elective surgeries.

DISCLOSURES:

This study was supported by ICES, which is funded by the Ontario Ministry of Health and the Ministry of Long-Term Care and the Sunnybrook AFP Innovation Fund. One author reported receiving grants during the conduct of the study and personal fees and grants outside the submitted work. Another author reported receiving consulting fees from pharmaceutical and medical device companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.