84: The association between familiarity of the surgeon-anesthesiologist dyad and post-operative patient outcomes for complex gastrointestinal cancer surgery: a population-based study.

Saturday, March 25, 2023

9:46 AM – 9:56 AM

Location: Ballroom B

Abstract Presenter(s)

Julie Hallet, MD MSc FRCSC FSSO (she/her/hers)

Associate Professor of Surgery
University of Toronto; Odette Cancer Centre - Sunnybrook Health Sciences Centre
Toronto, Ontario, Canada

Disclosure(s): AAA: Speaker (Terminated); AstraZeneca; Bristol Myers Squibb; BTG International Ltd.; MedImmune; and Merck & Co., Inc.: Speaker (Terminated); Ipsen: Speaker (Ongoing); Medtronic: Speaker (Ongoing); Olympus Corporation: Speaker (Ongoing)

First Author(s)

Julie Hallet, MD MSc FRCSC FSSO (she/her/hers)

Associate Professor of Surgery
University of Toronto; Odette Cancer Centre - Sunnybrook Health Sciences Centre
Toronto, Ontario, Canada

Disclosure(s): AAA: Speaker (Terminated); AstraZeneca; Bristol Myers Squibb; BTG International Ltd.; MedImmune; and Merck & Co., Inc.: Speaker (Terminated); Ipsen: Speaker (Ongoing); Medtronic: Speaker (Ongoing); Olympus Corporation: Speaker (Ongoing)

Author(s)

RS

Rinku Sutradhar, PhD

Professor
University of Toronto, United States

Disclosure information not submitted.
AJ

Angela Jerath, MD PhD

Associate Professor
University of Toronto, United States

Disclosure information not submitted.
PP

Pablo Perez d'Empaire, MD

Assistant Professor
University of Toronto, United States

Disclosure information not submitted.
FC

Francois Carrier, MD MSc

Anesthesiologist
CHUM, United States

Disclosure information not submitted.
AT

Alexis Turgeon, MD MSc

Anesthesiologist
CHU de québec, United States

Disclosure information not submitted.
DM

Daniel McIssac

Disclosure information not submitted.
cI

chris Idestrup, MD MSc

Anesthesiologist
University of Toronto, United States

Disclosure information not submitted.
GL

Gianni Lorello, MD MSc

Anesthesiologist
University of Toronto, United States

Disclosure information not submitted.
AF

Alana Flexman, MD

Anesthesiologist
UBC, United States

Disclosure information not submitted.
bK

biniam Kidane, MD MSc

Surgeon
University of Manitoba, United States

Disclosure information not submitted.
WC

Wing Chan, MPH

Analyst
IC/ES, United States

Disclosure information not submitted.
YK

Yosuf Kaliwal, MPH

analyst
ICES, United States

Disclosure information not submitted.
VB

Victoria Barabash, MSc

Research coordinator
Sunnybrook research institute, United States

Disclosure information not submitted.
Gursharan Sohi, MD(c)

Medical Student
Sunnybrook Research Institute
Toronto, Ontario, Canada

Disclosure information not submitted.
AE

Antoine Eskander, MD ScM

Assistant Professor
University of Toronto, United States

Disclosure information not submitted.

Disclosure(s):

Julie Hallet, MD MSc FRCSC FSSO: AAA: Speaker (Terminated); AstraZeneca; Bristol Myers Squibb; BTG International Ltd.; MedImmune; and Merck & Co., Inc.: Speaker (Terminated); Ipsen: Speaker (Ongoing); Medtronic: Speaker (Ongoing); Olympus Corporation: Speaker (Ongoing)

Introduction: The surgeon-anesthesiologist teamwork and relationship is crucial to good patient outcomes. Familiarity amongst work team members is associated with enhanced success in multiple fields, but rarely studied in the operating room. We examined the association between surgeon-anesthesiologist dyad familiarity – as the number of times working together – with short-term post-operative outcomes for complex gastrointestinal cancer surgery.

Methods: We conducted a population-based retrospective cohort study of adults undergoing esophagectomy, pancreatectomy, and hepatectomy for cancer over 2007-2018. The exposure was the surgeon-anesthesiologist dyad familiarity captured as the annual volume of procedures of interest done by the dyad in the 4 years before the index surgery. The outcome was 90-day major morbidity (any Clavien-Dindo grade 3-5). The association between exposure and outcome was examined using multivariable logistic regression.

Results: 7,893 patients cared for by 737 anesthesiologists and 163 surgeons were included. The median surgeon-anesthesiologist dyad volume was 1 (range: 0-12.2) procedures/year. 90-day major morbidity occurred in 43.0% of patients. There was a linear relationship between dyad volume and 90-day major morbidity (p=0.01). After adjustment, the annual dyad volume was independently associated with lower odds of 90-day major morbidity, with odds ratio 0.95 (95%CI 0.92-0.98; p=0.01) for each incremental procedure/year/dyad. The results did not change when examining 30-day major morbidity.

Conclusions: Among adults undergoing complex gastrointestinal cancer surgery, increasing familiarity of the surgeon-anesthesiologist dyad was associated with improved short-term patient outcomes. For each additional time that a unique surgeon-anesthesiologist dyad worked together, the odds of 90-day major morbidity decreased by 5%. This suggests that increasing the familiarity of surgeon-anesthesiologist dyads, or the number of procedures they do together, represents an opportunity to improve patient outcomes for complex gastrointestinal cancer surgery.

Learning Objectives:

To discuss the role of surgeon-anesthesiologist team dynamics in patient outcomes for surgical oncology
To describe how the familiarity between surgeon and anesthesiologist is associated with patient outcomes for surgical outcomes.
To understand implications of surgeon-anesthesiologist familiarity in work organization for surgical oncology care.