The better the surgeon and anesthetist know each other, the better for the patient. This is actually obvious, but has now also been proven in a study. We believe that good teamwork is particularly important in proctology, because this is a very sensitive part of the body that is also subject to shame and, in our opinion, patients need to be treated with particular care.
Imagine a surgeon who performs the operation and an anaesthetist who is responsible for anaesthesia and monitoring the patient during the procedure working as a perfectly coordinated duo in the operating room. A recent study from Canada has now shown very convincingly that it is precisely this well-coordinated teamwork that brings considerable benefits for patients: serious problems are simply much less likely to occur after the operation.
The key message: Familiar teams operate more safely
The researchers wanted to find out whether it makes a difference how well the operating surgeon and the anesthetist in charge know each other and how often they have worked together. The clear answer is: Yes, it makes a big difference! The conclusion of the study, which was published in the renowned medical journal JAMA Surgery, could be summarized as follows: “Every operation performed jointly by a well-established surgeon-anesthesiologist team helps to reduce the risk for patients.”
What exactly was investigated?
The scientists focused on so-called “serious postoperative complications”. These are serious health problems that can occur within 90 days (i.e. around three months) of a planned, high-risk operation. “Serious” in this context means that the complications were so severe that they required a repeat surgery, caused permanent damage or were even life-threatening (doctors use a classification called Clavien-Dindo, with grades 3 to 5 describing the severe cases).
An impressive amount of data was analyzed for this study: Information on a total of 711,006 surgeries. These procedures were performed between the years 2009 and 2019 in 95 different hospitals in the Ontario region of Canada. These were planned operations (so-called elective procedures) that were classified as high-risk from the outset.
The results in detail: Fewer complications due to team experience
The research team led by Dr. Julie Hallet from Sunnybrook Health Centre in Toronto was able to prove that every additional operation that a permanent team of two (surgeon and anaesthetist) performed together per year was associated with a measurable reduction in the risk of serious complications. It is important to note that the researchers statistically factored out other possible influencing factors, such as the age of the patients, their general state of health or the complexity of the respective procedure. This ensured that the positive effect observed was actually due to the improved teamwork.
Specifically, the results looked like this:
- For operations in the gastrointestinal tract (GIT for short), which are considered particularly risky, the risk of serious complications fell by 8% for each additional operation performed jointly as a team per year.
- For less risky operations in the gastrointestinal tract, this risk reduction still amounted to 4%.
- For operations due to cancer in the gynecological area (i.e. organs of the female reproductive system), the risk was reduced by 3%.
- And a risk reduction of 3% was also observed for operations on the spine.
The researchers not only examined the complication rate, but also the mortality rate within 30 days of the operation. Here too, a similar positive picture emerged: well-coordinated teams also tended to have better results.
Not equally clear for all types of surgery
Interestingly, this positive correlation was not equally evident for all types of surgery. The effect was not statistically “significant” for orthopaedic operations (e.g. on bones, joints), heart operations and lung operations. This means that it was not possible to say with absolute certainty whether the observed differences were actually due to team experience or whether they could have occurred by chance.
Dr. Hallet and her team have a possible explanation for this: it could be that fixed teams of two are already more common in these special surgical areas. So if teams already work together very often anyway, the additional benefit of another joint operation may not be as great.
Nevertheless, with the exception of lung operations, the researchers also found a correlation in these areas: the more operations a team performed together, the fewer health problems (medically known as “morbidity”) occurred in the patients.
No magic threshold, but every operation counts
The study was unable to identify an exact “threshold value” – i.e. a specific number of operations performed together at which the positive effect suddenly becomes particularly clear. Instead, it appears to be a continuous process: Every additional, shared experience is valuable.
On average (median value), the teams studied had only performed three or even fewer operations together per year. However, this figure was significantly higher for cardiac or orthopaedic operations, with an average of nine and eight joint operations per year respectively.
It is also important to understand that the basic risk of complications varies greatly depending on the type of procedure. For example, the rate of complications within 90 days of cardiac surgery was a very high 65% (i.e. almost two thirds of patients were affected), while it was just under 8% after orthopaedic surgery.
Why is that the case? Better teamwork leads to better results
The researchers assume that a feeling of familiarity and being part of a team in the operating room leads to noticeably better teamwork and more mutual trust. This in turn is reflected in better surgical results. You can imagine it like this: When surgeon and anesthesiologist know each other well, they often understand each other without many words. Collaboration is smoother, they can better anticipate each other’s actions and needs and support each other optimally. This all contributes to a smooth operation and reduces the likelihood of errors or unexpected problems occurring.
Dr. Hallet’s research group had already been able to demonstrate similar positive correlations between well-coordinated teams and better results in an earlier study, although this was limited to operations on the oesophagus and in the area of the pancreas, liver and bile ducts.
The study provides strong evidence that it is worthwhile for hospitals and surgical teams to rely on continuity and fixed team structures for surgeons and anesthetists. After all, if these key people work together regularly and are able to adapt well to each other, patients in particular benefit from a lower risk of serious complications after an operation. Incidentally, the well-coordinated team has been a reality in our everyday medical practice for many years; all specialists involved in a treatment or operation can rely on each other blindly. We can therefore only confirm the results of the study and the many positive responses from our patients also speak for themselves.
See you in the waiting room!