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Quality Improvement/Clinical Outcomes

E414: The impact of greater surgeon-anaesthetist familiarity on post-operative outcomes in complex major upper gastrointestinal cancer surgery

Introduction: The surgeon-anaesthetist dyad is an important relationship at the forefront of ensuring good post-operative outcomes. Greater familiarity and working relationships in the surgeon-anaesthetist dyad may be accrued through performing higher volumes of cases together. We hypothesise that the more, complex major upper gastrointestinal (UGI) surgical resections the surgeon and anaesthetist perform together, the lower the incidence of post-operative complications, particularly in patients of greater co-morbidity.

Methods: All patients who underwent major esophago-gastric or hepato-pancreatico-biliary resections for primary carcinoma or liver metastases at our tertiary, specialist cancer center from 2013-2022 were identified from a prospectively created database. The primary surgeon and anaesthetist, Charlson co-morbidity (CCM) score and ASA were recorded. Outcomes including post-operative complications as per the Clavien-Dindo (CD) classification, critical care unit (CCU) and total inpatient length of stay (LOS) were recorded. The median number of complex major resections performed per dyad was 23 and the median CCM score for all patients was 4. Dyads were stratified into high volume (≥23 cases/dyad) vs low volume (< 23 cases/dyad), and cases into high co-morbidity (CCM≥4) vs low co-morbidity CCM (< 4).

Results: A total of n=618 (n=185 female) cases performed by 6 attending surgeons and 35 attending anaesthetists (78 dyads) were included. The highest number of cases performed by 1 surgeon-anaesthetist dyad was 85. Most patients were ASA=3 (n=306, 50%). The highest CCM score recorded was 12. High volume dyads were more likely to operate on higher risk (ASA III-IV) cases (p< 0.001). Patients of greater co-morbidity (CCM≥4) had a higher incidence of CD grade I (3.1%), II (45.3%) and III (25.0%) complications when operated on by low volume dyads compared to high volume dyads (1.8%, 36.7% and 22.0% respectively- not statistically significant).

Conclusions: Greater familiarity between the surgeon and anaesthetist may be developed through operating on a higher volume of cases together (dyad volume). High volume dyads may safely perform major UGI surgical resections for cancer on higher risk (ASA III-IV) cases without significant increase in inpatient mortality, CCU or total LOS. The surgeon-anaesthetist dyad should be considered in pre-operative planning for major UGI cancer surgery, particularly for higher risk patients.

Learning Objectives:

  • Upon completion, participant will be able to understand the potential impact of surgeon-anaesthetist familiarity on post-operative outcomes in complex major upper gastrointestinal surgery for cancer.
  • Upon completion, participant will be able to infer that greater familiarity between the surgeon and anaesthetist may be developed by operating on a higher volume of cases together.
  • Upon completion, participant may be able to apply the conclusions of this study to pre-operative planning in their home institution.