Evaluating the Impact of Operative Team Familiarity on Cardiac Surgery Outcomes: A Retrospective Cohort Study of Medicare Beneficiaries.

Autor:	Awtry JA; Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.; Center for Surgery and Public Health, Boston, MA., Abernathy JH; Division of Cardiac Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, MD., Wu X; Department of Cardiac Surgery, Section of Health Services Research and Quality, Michigan Medicine, Ann Arbor, MI., Yang J; Department of Cardiac Surgery, Section of Health Services Research and Quality, Michigan Medicine, Ann Arbor, MI., Zhang M; Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI., Hou H; Department of Cardiac Surgery, Section of Health Services Research and Quality, Michigan Medicine, Ann Arbor, MI., Kaneko T; Division of Cardiothoracic Surgery, Washington University in St Louis/Barnes-Jewish Hospital, St. Louis, MO., de la Cruz KI; Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA., Stakich-Alpirez K; Department of Cardiac Surgery, Section of Health Services Research and Quality, Michigan Medicine, Ann Arbor, MI., Yule S; School of Surgery, University of Edinburgh, Scotland, UK., Cleveland JC Jr; Division of Cardiothoracic Surgery, University of Colorado Anschutz Medical Center, Aurora, CO., Shook DC; Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA., Fitzsimons MG; Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA., Harrington SD; Henry Ford Macomb Hospital, Clinton Township, MI., Pagani FD; Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI., Likosky DS; Department of Cardiac Surgery, Section of Health Services Research and Quality, Michigan Medicine, Ann Arbor, MI.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2024 May 01; Vol. 279 (5), pp. 891-899. Date of Electronic Publication: 2023 Sep 27.
DOI:	10.1097/SLA.0000000000006100
Abstrakt:	Objective: To associate surgeon-anesthesiologist team familiarity (TF) with cardiac surgery outcomes. Background: TF, a measure of repeated team member collaborations, has been associated with improved operative efficiency; however, examination of its relationship to clinical outcomes has been limited. Methods: This retrospective cohort study included Medicare beneficiaries undergoing coronary artery bypass grafting (CABG), surgical aortic valve replacement (SAVR), or both (CABG+SAVR) between January 1, 2017, and September 30, 2018. TF was defined as the number of shared procedures between the cardiac surgeon and anesthesiologist within 6 months of each operation. Primary outcomes were 30- and 90-day mortality, composite morbidity, and 30-day mortality or composite morbidity, assessed before and after risk adjustment using multivariable logistic regression. Results: The cohort included 113,020 patients (84,397 CABG; 15,939 SAVR; 12,684 CABG+SAVR). Surgeon-anesthesiologist dyads in the highest [31631 patients, TF median (interquartile range)=8 (6, 11)] and lowest [44,307 patients, TF=0 (0, 1)] TF terciles were termed familiar and unfamiliar, respectively. The rates of observed outcomes were lower among familiar versus unfamiliar teams: 30-day mortality (2.8% vs 3.1%, P =0.001), 90-day mortality (4.2% vs 4.5%, P =0.023), composite morbidity (57.4% vs 60.6%, P <0.001), and 30-day mortality or composite morbidity (57.9% vs 61.1%, P <0.001). Familiar teams had lower overall risk-adjusted odds of 30-day mortality or composite morbidity [adjusted odds ratio (aOR) 0.894 (0.868, 0.922), P <0.001], and for SAVR significantly lower 30-day mortality [aOR 0.724 (0.547, 0.959), P =0.024], 90-day mortality [aOR 0.779 (0.620, 0.978), P =0.031], and 30-day mortality or composite morbidity [aOR 0.856 (0.791, 0.927), P <0.001]. Conclusions: Given its relationship with improved 30-day cardiac surgical outcomes, increasing TF should be considered among strategies to advance patient outcomes. Competing Interests: Dr J.H.A. receives funding from the Agency for Healthcare Research and Quality; is a member of the Society of Cardiovascular Anesthesiologists Board of Directors; serves on the advisory board for Intelliport. Dr T.K. is a consultant receiving advisor, speaking, or lecture fees from Edwards Lifesciences Corporation, Abbott Laboratories, and Medtronic Inc. Dr K.I.d.l.C. is a consultant receiving advisor, speaking, or lecture fees from Edwards Lifesciences Corporation and Terumo Aortic. Dr S.Y. receives consulting fees from Johnson & Johnson Institute. Dr J.C.C. is a consultant for Abbott Laboratories and Edwards Lifesciences. Dr D.C.S. is a consultant receiving consulting and speaking fees from Edwards Lifesciences. Dr F.D.P. is a noncompensated ad-hoc scientific advisor for Abbott, CH Biomedical, FineHeart, and Medtronic; noncompensated medical monitor for Abiomed; Member, Data Safety Monitoring Board for Carmat and the National Heart, Lung, and Blood Institute PumpKIN Study; receives grant funding from the National Heart, Lung, and Blood Institute and the Agency for Healthcare Research and Quality; and receives partial salary support from Blue Cross/Blue Shield of Michigan as Associate Director of the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative. Dr D.S.L. has received a research grant from the National Institutes of Health (NHLBI R01HL146619). Outside of this work, Dr D.S.L.: (1) received research funding from the Agency for Healthcare Research and Quality, and the National Institutes of Health; (2) served as a consultant for the American Society of Extracorporeal Technology; and (3) received partial salary support from Blue Cross Blue Shield of Michigan to advance quality in Michigan in conjunction with the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative. Dr X.W. and Dr J.Y. had full access to all the data in the study and assume responsibility for the integrity of the data and the accuracy of the data analysis. The remaining authors report no conflicts of interest. (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
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