Michael R Mathis1, Steven Yule2, Xiaoting Wu3, Roger D Dias4, Allison M Janda5, Sarah L Krein6, Milisa Manojlovich7, Matthew D Caldwell5, Korana Stakich-Alpirez3, Min Zhang8, Jason Corso9, Nathan Louis10, Tongbo Xu8, Jeremy Wolverton11, Francis D Pagani12, Donald S Likosky13. 1. Department of Anesthesiology, Michigan Medicine, University of Michigan, Ann Arbor, MI. Electronic address: https://twitter.com/Michael_Mathis. 2. Department of Clinical Surgery, University of Edinburgh, Scotland; Department of Surgery, Brigham & Women's Hospital/Harvard Medical School, Boston, MA. Electronic address: https://twitter.com/NOTSS_lab. 3. Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI. 4. Department of Emergency Medicine, Brigham & Women's Hospital/ Harvard Medical School, Boston, MA. Electronic address: https://twitter.com/RogerDDias. 5. Department of Anesthesiology, Michigan Medicine, University of Michigan, Ann Arbor, MI. 6. Department of Internal Medicine, University of Michigan and Veterans Affairs Ann Arbor Healthcare System, MI. Electronic address: https://twitter.com/Sarahlkrein. 7. School of Nursing, University of Michigan, Ann Arbor, MI. Electronic address: https://twitter.com/mmanojlo. 8. Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI. 9. Department of Electrical Engineering and Computer Science, College of Engineering, University of Michigan, Ann Arbor, MI. Electronic address: https://twitter.com/ProfJasonCorso. 10. Department of Electrical Engineering and Computer Science, College of Engineering, University of Michigan, Ann Arbor, MI. 11. Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI. Electronic address: https://twitter.com/JeremyWolverton. 12. Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI. Electronic address: https://twitter.com/FPaganiMD. 13. Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI. Electronic address: likosky@med.umich.edu.
Abstract
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.
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.
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