• Jake A Awtry, James H Abernathy, Xiaoting Wu, Jie Yang, Min Zhang, Hechuan Hou, Tsuyoshi Kaneko, Kim I de la Cruz, Korana Stakich-Alpirez, Steven Yule, Joseph C Cleveland, Douglas C Shook, Michael G Fitzsimons, Steven D Harrington, Francis D Pagani, Donald S Likosky, and Video Assessment of caRdiac Surgery qualITY (VARSITY) Surgery Investigators.
• Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
• Ann. Surg. 2024 May 1; 279 (5): 891899891-899.

ObjectiveTo associate surgeon-anesthesiologist team familiarity (TF) with cardiac surgery outcomes.BackgroundTF, 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.MethodsThis 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.ResultsThe 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].ConclusionsGiven its relationship with improved 30-day cardiac surgical outcomes, increasing TF should be considered among strategies to advance patient outcomes.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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