Surgeon-Anesthesiologist Familiarity and Short-Term Outcomes in Complex Gastrointestinal Cancer Surgery

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In a Canadian population–based retrospective cohort study reported in JAMA Surgery, Hallet et al found that increased familiarity among surgeon-anesthesiologist dyads—measured by annual number of procedures performed together—was associated with better short-term postoperative outcomes in complex surgery for patients with gastrointestinal cancers.

Study Details

The study involved data from 7,893 patients undergoing esophagectomy, pancreatectomy, or hepatectomy for cancer in Ontario from 2007 through 2018. Care was provided by 737 anesthesiologists and 163 surgeons.

Dyad familiarity was defined by the annual volume of procedures of interest performed by the surgeon-anesthesiologist dyad in the 4 years prior to the index surgery. The main outcome measure was 90-day major morbidity, defined as any Clavien-Dindo grade 3 to 5 complication.

Key Findings

The median surgeon-anesthesiologist dyad volume was 1 procedure per year, with a range of 0 to 12.2 procedures per year. Major morbidity at 90 days occurred in 43.0% of patients.

In an analysis adjusting for hospital setting; hospital annual volume; surgeon annual volume; and patient age, sex, and comorbidities, there was a linear association between dyad volume and 90-day major morbidity (P = .01).

In adjusted analysis, annual dyad volume was independently associated with lower risk of 90-day major morbidity, with an adjusted odds ratio of 0.95 (95% confidence interval [CI] = 0.92–0.98, P = .01) for each incremental procedure per year per dyad. Adjusted analysis for 30-day major morbidity showed similar results, with an adjusted odds ratio of 0.95 (95% CI = 0.91–0.99, P = .02) for each incremental procedure per year per dyad.  

The investigators concluded, “Among adults undergoing complex gastrointestinal cancer surgery, increasing familiarity of the surgeon-anesthesiologist dyad was associated with improved short-term patient outcomes. For each additional time that a unique surgeon-anesthesiologist dyad worked together, the odds of 90-day major morbidity decreased by 5%. These findings support organizing perioperative care to increase the familiarity of surgeon-anesthesiologist dyads.”

Julie H. Hallet, MD, MSc, of Sunnybrook Health Sciences Centre, Toronto, is the corresponding author for the JAMA Surgery article.

Disclosure: The study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Ministry of Long-Term Care, and by the Sunnybrook Alternate Funding Plan Innovation Fund. For full disclosures of the study authors, visit

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