Study: Surgeon-anesthesiologist familiarity could reduce complications in select surgeries

Editor's Note

Greater familiarity between surgeons and anesthesiologists was associated with reduced major morbidity in certain high-risk procedures, according to a Canadian retrospective cohort study published in JAMA Surgery.

As detailed in a May 28 report from MedPage Today, the population-based analysis included more than 711,000 index procedures, finding an independent association between surgeon-anesthesiologist dyad volume and 90-day major morbidity in four specific surgeries: high-risk gastrointestinal, low-risk gastrointestinal, gynecologic oncology, and spine. Adjusted odds ratios for reduced morbidity in these procedures were:

• High-risk gastrointestinal surgery (OR 0.92, 95% CI 0.88–0.96)
• Low-risk gastrointestinal surgery (OR 0.96, 95% CI 0.95–0.98)
• Gynecologic oncology surgery (OR 0.97, 95% CI 0.94–0.99)
• Spine surgery (OR 0.97, 95% CI 0.96–0.99)

These associations were not statistically significant for cardiac, lung, head and neck, vascular, neurologic, genitourinary, or orthopedic procedures. Study author Julie H. Hallet, MD, MSc, of Sunnybrook Health Sciences Centre in Toronto, told MedPage Today that familiar dyads “develop shared mental models, trust, and more efficient communication, allowing them to anticipate each other’s needs, manage crises more effectively, and minimize errors.” She added that this familiarity can also “streamline workflow, reduce disruptions, and encourage mutual support in the operating room.”

As detailed in the article, the researchers defined dyad volume as the annual number of times a surgeon and anesthesiologist performed the same type of procedure together over the previous four years. Major morbidity was defined as Clavien-Dindo grade 3 to 5 events, including death. The incidence of major morbidity ranged from 65.2% in cardiac surgery to 9.7% in spine surgery—variability that could be explained by different care structures and baseline risks, with some procedures (cardiac, lung, orthopedic) having higher median dyad volumes and greater familiarity.

Acknowledging that consistent team pairings may be difficult to implement, Dr Hallet told MedPage Today that schedulers should first evaluate current pairing patterns, then consider piloting consistent dyads for high-risk procedures with low familiarity—specifically gastrointestinal, gynecologic oncology, and spine surgeries.  

In an accompanying commentary, Jasmine Hwang, MD, and Rachel R. Kelz, MD, of the University of Pennsylvania, wrote that the findings “make coordinated scheduling of consistent surgeon-anesthesiologist dyads (and nurse staffing) an attractive process measure for surgical quality improvement.” However, they also caution that “Consistent pairings could threaten physician readiness to work with unfamiliar partners.”  

The full report offers additional detail and context on the study’s methodology and limitations, including quotes from authors, as well as the statements made in the accompanying commentary.