The odds of patient complications following high-risk surgeries are lower when the surgeon and anesthesiologist have prior experience working together, according to a new study by researchers at ICES, Sunnybrook Research Institute and the University of Toronto.

The findings come from an analysis of data from hundreds of thousands of high-risk surgeries in Ontario over a 10-year period, along with information on the surgeon and anesthesiologist for each procedure and how often the pair had worked together in the previous four years.

The study, which was recently published in JAMA Surgery, highlights the potential of using team design to improve patient outcomes.

“Team design is used in a lot of other fields like business and sports, but it’s overlooked in health care,” says lead author Julie Hallet, a scientist at Sunnybrook Research Institute and an associate professor of surgery at U of T’s Temerty Faculty of Medicine.

“Health care is one of the only areas where we expect people who have never worked together—who sometimes have never met before—to perform at peak levels in the most stressful circumstances.”

As a surgeon, Hallet knows firsthand how the environment in an operating room can change depending on team members’ familiarity with each other. It’s something that she and her colleagues have all observed, but until recently, lacked the data to describe.

To study this question, Hallet and colleagues analyzed population-based health-care data from 711,005 high-risk elective surgeries performed in Ontario between 2009 and 2019, and corresponding information on surgeon-anesthesiologist teams.

They found that for surgeries related to the gastrointestinal tract, spine and gynecological cancers, there was an association between surgeon–anesthesiologist familiarity and the odds of severe complications in the 90 days after surgery. For each additional procedure performed by the same surgeon–anesthesiologist pair, the likelihood of experiencing a severe complication decreased by 3–8%.

“Those are meaningful differences because severe post-operative complications can lead to additional surgeries, ICU stays or even death,” says Hallet.

The researchers also noted that for most procedures, the average surgeon–anesthesiologist pair was in the operating room together three times a year or less. The exceptions were orthopedic and cardiac surgery, where surgeons teamed up with the same anesthesiologist for eight and nine procedures each year, respectively, on average.

These procedures had greater team stability because anesthesiologists require specialized training to participate in cardiac surgeries, and orthopedic surgeries are often done at dedicated centers like Sunnybrook’s Holland Centre.

“In those particular procedures where they’ve achieved team stability, we do not see an association because the team already has a high degree of familiarity,” says Hallet.

The findings show that unlike expensive new technologies or drugs, optimizing the makeup of surgical teams to foster consistency and familiarity could be a no-cost way to improve patient outcomes.

Hallet acknowledges that there are challenges and potential drawbacks to adopting a team design-centered approach to organizing and scheduling surgeries. One possible consequence could be that anesthesiologists, most of whom are currently considered generalists, become increasingly specialized and less comfortable stepping in to cover other procedures.

In the next phase of this project, the researchers are looking at this and other factors that can support the implementation of more stable teams in the operating room.

The team is currently interviewing anesthesiologists and surgeons to understand their perspectives about the different models of care and what concerns need to be addressed to enable the adoption of this new approach. They’re also doing a cost analysis to determine how much money hospitals and health systems could save by having more familiar surgical teams and fewer post-operative complications.

“You can’t put team stability or team familiarity in a bottle or replicate its effects through protocols or processes,” says Hallet. “The only way that you can get that effect is by putting people together more often and having them work and succeed together.”