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The impact of team familiarity on intra and postoperative cardiac surgical outcomes.

Mathis MR, Yule S, Wu X, Dias RD, Janda AM, Krein SL, Manojlovich M, Caldwell MD, Stakich-Alpirez K, Zhang M, Corso J, Louis N, Xu T, Wolverton J, Pagani FD, Likosky DS, Video Assessment Cardiac Surgery Quality (VARSITY) Group. Electronic address: https://twitter.com/SurgeryVarsity. The impact of team familiarity on intra and postoperative cardiac surgical outcomes. Surgery. 2021 Oct 1; 170(4):1031-1038.

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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.





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