The Association Between Surgeon-Anesthesiologist Dyad Familiarity and Operative Mortality: A Retrospective Study at a Large Academic Cardiac Surgery Program.

Abstract

BACKGROUND Effective teamwork is essential in high-stakes environments such as cardiac surgery, where complex procedures require coordinated efforts, particularly between surgeons and anesthesiologists. While team dynamics have been shown to affect surgical outcomes, the impact of surgeon-anesthesiologist familiarity on operative mortality in cardiac surgery remains underexplored. We aimed to assess whether increased familiarity within this dyad was associated with reduced operative mortality and improved patient outcomes. METHODS We conducted a retrospective, single-center cohort study using data from a large academic medical center, covering cases from July 2011 to January 2024. Surgeon-anesthesiologist dyads were defined by unique pairings who worked together in each case. Familiarity was measured by the frequency of collaboration over the previous 365 days and divided into quintiles. The primary outcome was operative mortality, defined as death before discharge or within 30 days post-procedure. Secondary outcomes included operative length, hospital and intensive care length of stay, reoperation, readmission, and reported organ system complications. A logistic mixed-effects model adjusted for patient demographics, comorbidities, and procedure type, was used to examine associations. RESULTS We identified 481 unique surgeon-anesthesiologist pairs from 16,811 cases. Higher dyad familiarity was associated with significantly lower operative mortality when analyzing the entire cohort (P < .001). Patients cared for by higher-familiarity dyads also had reduced rates of several adverse outcomes, although deep sternal wound infection showed no association with dyad familiarity. After adjusting for confounders, the odds of operative mortality were significantly higher for the lowest-familiarity dyads compared to the highest-familiarity dyads (odds ratio [OR], 1.90, 95% confidence interval [CI], 1.29-2.81, P = .001). CONCLUSIONS Increased surgeon-anesthesiologist familiarity was associated with lower operative mortality and improved outcomes in cardiac surgery, highlighting the importance of consistent team collaboration. Multi-center studies are warranted to validate these findings and explore familiarity's effects across diverse clinical settings.