The impact of team familiarity on intra and postoperative cardiac surgical outcomes.
Aged
Cardiac Surgical Procedures
/ ethics
Heart Diseases
/ surgery
Humans
Middle Aged
Morbidity
/ trends
Operative Time
Postoperative Complications
/ epidemiology
Recognition, Psychology
Retrospective Studies
Risk Factors
Surgeons
/ ethics
Survival Rate
/ trends
Treatment Outcome
United States
/ epidemiology
Journal
Surgery
ISSN: 1532-7361
Titre abrégé: Surgery
Pays: United States
ID NLM: 0417347
Informations de publication
Date de publication:
10 2021
10 2021
Historique:
received:
17
01
2021
revised:
19
04
2021
accepted:
14
05
2021
pubmed:
22
6
2021
medline:
26
11
2021
entrez:
21
6
2021
Statut:
ppublish
Résumé
Familiarity among cardiac surgery team members may be an important contributor to better outcomes and thus serve as a target for enhancing outcomes. Adult cardiac surgical procedures (n = 4,445) involving intraoperative providers were evaluated at a tertiary hospital between 2016 and 2020. Team familiarity (mean of prior cardiac surgeries performed by participating surgeon/nonsurgeon pairs within 2 years before the operation) were regressed on cardiopulmonary bypass duration (primary-an intraoperative measure of care efficiency) and postoperative complication outcomes (major morbidity, mortality), adjusting for provider experience, surgeon 2-year case volume before the surgery, case start time, weekday, and perioperative risk factors. The relationship between team familiarity and outcomes was assessed across predicted risk strata. Median (interquartile range) cardiopulmonary bypass duration was 132 (91-192) minutes, and 698 (15.7%) patients developed major postoperative morbidity. The relationship between team familiarity and cardiopulmonary bypass duration significantly differed across predicted risk strata (P = .0001). High (relative to low) team familiarity was associated with reduced cardiopulmonary bypass duration for medium-risk (-24 minutes) and high-risk (-27 minutes) patients. Increasing team familiarity was not significantly associated with the odds of major morbidity and mortality. Team familiarity, which was predictive of improved intraoperative efficiency without compromising major postoperative outcomes, may serve as a novel quality improvement target in the setting of cardiac surgery.
Sections du résumé
BACKGROUND
Familiarity among cardiac surgery team members may be an important contributor to better outcomes and thus serve as a target for enhancing outcomes.
METHODS
Adult cardiac surgical procedures (n = 4,445) involving intraoperative providers were evaluated at a tertiary hospital between 2016 and 2020. Team familiarity (mean of prior cardiac surgeries performed by participating surgeon/nonsurgeon pairs within 2 years before the operation) were regressed on cardiopulmonary bypass duration (primary-an intraoperative measure of care efficiency) and postoperative complication outcomes (major morbidity, mortality), adjusting for provider experience, surgeon 2-year case volume before the surgery, case start time, weekday, and perioperative risk factors. The relationship between team familiarity and outcomes was assessed across predicted risk strata.
RESULTS
Median (interquartile range) cardiopulmonary bypass duration was 132 (91-192) minutes, and 698 (15.7%) patients developed major postoperative morbidity. The relationship between team familiarity and cardiopulmonary bypass duration significantly differed across predicted risk strata (P = .0001). High (relative to low) team familiarity was associated with reduced cardiopulmonary bypass duration for medium-risk (-24 minutes) and high-risk (-27 minutes) patients. Increasing team familiarity was not significantly associated with the odds of major morbidity and mortality.
CONCLUSION
Team familiarity, which was predictive of improved intraoperative efficiency without compromising major postoperative outcomes, may serve as a novel quality improvement target in the setting of cardiac surgery.
Identifiants
pubmed: 34148709
pii: S0039-6060(21)00439-6
doi: 10.1016/j.surg.2021.05.020
pmc: PMC8733606
mid: NIHMS1716477
pii:
doi:
Types de publication
Journal Article
Observational Study
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
1031-1038Subventions
Organisme : NHLBI NIH HHS
ID : R01 HL146619
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL126896
Pays : United States
Organisme : NHLBI NIH HHS
ID : K01 HL141701
Pays : United States
Organisme : NIGMS NIH HHS
ID : T32 GM103730
Pays : United States
Organisme : HSRD VA
ID : RCS 11-222
Pays : United States
Informations de copyright
Copyright © 2021 Elsevier Inc. All rights reserved.
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