Team Familiarity: Key to Better Outcomes in Surgery?
Familiarity between surgeons and anesthesiologists was associated with improved outcomes in gastrointestinal, gynecologic oncologic, and spine surgeries, with each additional procedure performed together associated with reduced odds of 90-day postoperative major morbidity.
METHODOLOGY:
Researchers conducted a retrospective cohort study using administrative healthcare data in Canada to assess the link between how often teams of surgeons and anesthesiologists worked together and outcomes for their patients.
They included men and women aged 18 years or older who underwent high-risk elective surgeries with a postoperative stay over 24 hours from 2009 to 2019.
Clinician familiarity was measured by case volume, defined as the average annual number of procedures performed by the same surgeon-anesthesiologist pair in the 4 years prior to the index operation.
Procedures included cardiac, high- and low-risk GI, genitourinary, gynecologic oncologic, orthopedic, neurosurgery, spine, thoracic, vascular, and head and neck surgeries.
The primary outcome was 90-day major morbidity.
TAKEAWAY:
The analysis included 711,006 procedures. For most surgeries, the median dyad volume was three or fewer procedures per team per year, except for cardiac and orthopedic surgeries, which had median volumes of nine and eight procedures per group per year, respectively.
Each additional procedure per year for the same surgeon-anesthesiologist pair was associated with a 4% reduction in the odds of 90-day morbidity for low-risk GI surgery (adjusted odds ratio [aOR], 0.96; 95% CI, 0.95-0.98) and an 8% reduction in the odds for high-risk GI surgery (aOR, 0.92; 95% CI, 0.88-0.96).
For gynecologic oncologic and spine surgeries, each additional procedure performed per year by the same surgeon-anesthesiologist pair was associated with a 3% reduction in the odds of 90-day morbidity (aOR, 0.97; 95% CI, 0.94-0.99 and aOR, 0.97; 95% CI, 0.96-0.99, respectively). No significant association was found for other procedures.
Dyad volume was also independently associated with 30-day major morbidity for high-risk (aOR, 0.90; 95% CI, 0.86-0.94) and low-risk (aOR, 0.96; 95% CI, 0.94-0.97) GI surgeries.
IN PRACTICE:
'These findings indicate that for each additional procedure performed by a specific surgeon-anesthesiologist dyad, there is a corresponding decrease in the likelihood of experiencing 90-day major morbidity. Each procedure done together matters,' the authors of the study wrote.
'Increasing the familiarity of surgeon-anesthesiologist dyads or the number of procedures they do together represents an opportunity to improve patient outcomes for GI, gynecology oncology, and spine surgery,' they added.
'These results make coordinated scheduling of consistent surgeon-anesthesiologist dyads (and nurse staffing) an attractive process measure for surgical quality improvement,' experts wrote in an commentary accompanying the journal article.
SOURCE:
The study was led by Julie Hallet, MD, MSc, of the Department of Surgery at the University of Toronto, Toronto, Ontario, Canada. It was published online on May 28, 2025, in JAMA Surgery .
LIMITATIONS:
The use of routinely collected health administrative data may have introduced the risk for misclassification and limited the details on factors affecting patient outcomes. Owing to the focus on surgeon-anesthesiologist dyads, the contributions from other team members, such as nurses, trainees, and assistants, were excluded. The analysis was limited to high-risk and elective surgeries.
DISCLOSURES:
This study was supported by ICES, which is funded by the Ontario Ministry of Health and the Ministry of Long-Term Care and the Sunnybrook AFP Innovation Fund. One author reported receiving grants during the conduct of the study and personal fees and grants outside the submitted work. Another author reported receiving consulting fees from pharmaceutical and medical device companies.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
CBS News
12 minutes ago
- CBS News
Allina Health doctors, PAs hold first-ever union picket, ask for better work-life balance in new contract
Six hundred Allina doctors, physician assistants and nurse practitioners who work in primary care are asking for a new contract with more work-life balance. They gathered in the pouring rain Tuesday morning for a first-of-its-kind protest. "We are here together as a result of many years of fighting, fighting for primary care and fighting to make things better," workers chanted. While nurses have walked the picket line for years, these picketers are doctors, PA's and nurse practitioners who are admittedly higher compensated. "We all get paid really well, its not about that. It's about having better support for our patients and support in our community and that we want a fair treatment in our contract and protections for everybody," said Dr. Chris Filetti, a pediatrician with Allina Health. WCCO The workers are asking for paid sick leave, instead of having to use vacation time. They're also asking for four hours a week to finish paperwork, instead of doing it in their off time. Additionally, they're asking for more medical assistants and nurses for support. "As a provider I hear story after story about providers who have to cut back from practice because of poor work-life balance," said Filetti. Allina's leaders say they are listening despite the unsettled contract, telling WCCO in a statement: "We continue to negotiate in good faith to reach responsible agreements that maintain competitive pay and benefits for our providers while ensuring that we can sustain our caring mission during these extremely uncertain economic times. It is important to get it right. We remain committed to reaching fair agreements that ensure we can maintain access to the high-quality care people depend on."
Health Line
26 minutes ago
- Health Line
What Causes Two Periods in One Month?
If you have a shorter menstrual cycle, you may get your period twice in the same month. But bleeding between periods can also occur with certain medical conditions. A typical adult menstrual cycle ranges from 21 to 35 days, and the typical menstrual cycle for preteens and teens can last 38 days or longer. However, every woman is different, and each person's cycle can vary from month to month. During some months, your cycle may last for more or fewer days than the previous month, or it may start earlier or later than it has before. If your cycles are on the shorter end of the spectrum, you could have your period at the beginning and end of the same month with no reason for concern. But if you experience bleeding outside of your usual menstrual cycle and suspect you're having a second period, the first thing you should do is figure out if it's spotting or menstrual bleeding: If you're having menstrual bleeding, also known as your period, you should expect to soak through a pad or tampon every few hours. The blood may be dark red, red, brown, or pink. If you're having spotting, you won't bleed enough to fill a pad or tampon. Blood from spotting is usually dark red or brown. After you've determined if you're having spotting or menstrual bleeding, you can start to explore what may be causing your increased bleeding. This article reviews potential causes and treatment options. What causes two periods in one month? Increased bleeding may be caused by a shorter menstrual cycle, or by a health condition that causes vaginal bleeding. Causes of a shorter cycle If your cycle suddenly becomes shorter, it could be due to any of the following: anovulation (lack of ovulation) hyperthyroidism hypothyroidism onset of menopause (also known as perimenopause) uterine fibroids or cysts uterine polyps cervical polyps stress extreme weight loss or gain birth control illness Conditions that cause extra bleeding If you usually have a regular cycle, a change in your cycle, such as suddenly having two periods in a month, could indicate a medical condition. Some health conditions cause bleeding that can be mistaken for a period, including: Pregnancy can cause spotting. Spotting during pregnancy can occur, but you should tell your doctor about any bleeding during pregnancy. Sexually transmitted infections can cause discharge and bleeding. Polycystic ovary syndrome (PCOS) is a hormonal condition that can cause irregular periods. Perimenopause can cause heavier and more frequent bleeding, it can also cause lighter or less frequent bleeding. While our hormones may become more unbalanced during this time, they should regulate once you've reached menopause. Miscarriage can cause heavy bleeding. If you suspect you're pregnant and begin to have bleeding similar to a period, call your doctor. Cervicitis. Cervical infections that are not sexually transmitted can also cause bleeding. What are the risk factors for unusual menstrual bleeding? If you have just started getting your period due to puberty, it's possible that you will be irregular for a year or two, which means you may possibly experience two periods in one month. If you are an adult and have a family history of fibroids, cysts, or early-onset menopause, you're at an increased risk of having two periods in a month. However, an increased risk does not mean you will definitely experience it. When should you see a doctor about irregular menstrual cycles? While two periods in one month is not always a cause for concern, it's a good idea to consult a doctor anytime your body's rhythms seem out of whack. For example, you should see a doctor if you: experience pain in your lower abdomen that doesn't go away after a couple of days have very heavy periods spot or bleed in between periods (which is often mistaken for two periods in one month) experience pain during sexual intercourse have more menstrual cramping than usual notice dark clots during your period What are the complications of more frequent menstrual cycles? There are a few complications that may arise from irregular periods. Anemia One health issue of more frequent bleeding is anemia, which occurs due to a lack of iron in your blood. Your doctor can check your iron levels to determine the cause of your abnormal bleeding. The symptoms of anemia can include: fatigue headache weakness dizziness shortness of breath rapid or irregular heartbeat A singular experience of two periods in one month will not necessarily cause anemia. The condition is usually triggered by prolonged heavy bleeding, such as several months of heavy periods. Difficulty tracking ovulation Having two periods in one month may make it difficult to track your ovulation, especially if this experience is unusual for you. If you are not planning on becoming pregnant, practicing safe sex is essential. Difficulty becoming pregnant If you are trying to become pregnant, abnormal bleeding can add complexity to the process. Consult with a doctor if you are actively trying to become pregnant and are experiencing heavy or irregular periods. How are frequent menstrual cycles treated? Your treatment will depend on the underlying cause of your frequent bleeding. If you naturally have shorter cycles or if you've recently started menstruating, you won't need treatment. If anemia is a concern, your doctor may recommend iron supplements. One possible treatment for periods that occur too frequently is hormonal birth control. This type of birth control can help regulate your periods and help resolve anemia issues caused by heavy bleeding. Here are treatments for other possible causes of frequent bleeding. Hypothyroidism If you have hypothyroidism, it means you have an underactive thyroid gland. Your body can't make enough of the thyroid hormone. Your doctor will prescribe a thyroid hormone replacement therapy that you can take by mouth. Hyperthyroidism If you have hyperthyroidism, it means you have an overactive thyroid gland. Your body makes too much thyroid hormone. Several treatments are available for this condition. Your doctor will suggest what they think is best for you. Menopause During perimenopause or the menopausal transition, your doctor may prescribe hormone therapy and estrogen replacement therapy. These treatments can help regulate your periods until they slowly disappear as menopause progresses. Fibroids and cysts Your doctor may recommend a few different treatment options if you have uterine fibroids or cysts. These can include: Intrauterine device (IUD). An IUD is a form of birth control that can help relieve heavy periods. However, it won't shrink fibroids. MRI-guided ultrasound surgery. This procedure is performed while you're inside an MRI scanner. It's considered noninvasive, and doctors can use it to remove the fibroid or cyst. This procedure is only done in specialized clinics. Uterine artery embolization. This is a minimally invasive procedure that blocks the blood supply to the uterus, which causes the fibroids to decay and shrink. Myomectomy. There are different types of myomectomy, which is a surgical procedure to remove fibroids. In a hysteroscopic myomectomy, the fibroid is removed through the cervix. No incisions are needed. In a laparoscopic myomectomy, small incisions are made in your abdomen to remove fibroids. An abdominal myomectomy is an open abdominal surgical procedure. Hysteroscopy. During this procedure, a thin tube with a light on the end is inserted through the vagina. This allows a doctor to look inside the uterus and diagnose the cause of abnormal bleeding. A doctor may also be able to treat some causes of bleeding during a hysteroscopy. Dilation and curettage (D and C). This procedure involves the dilation of the cervix, which allows a doctor to scrape the uterine lining to remove any abnormal tissue. Endometrial ablation. This surgery involves the removal of the endometrial lining of the uterus. It is not usually recommended if you wish to have children later in life, as it can cause complications. Hysterectomy. A hysterectomy is a surgical procedure to remove the uterus. Gonadotropin-releasing hormone agonists. These are medications that can help treat fibroids. They block estrogen and progesterone and put you into a temporary postmenopausal state. This stops the fibroids from growing and can make them shrink. Your doctor may use this treatment to help prepare you for surgery. Stress Lifestyle changes can greatly affect stress levels, which in turn can affect menstrual cycles. To help relieve stress, try exercising frequently, practicing meditation, or engaging in talk therapy. If you're feeling stressed because you're overcommitted, ask for help. Finding the time to relax is important to your health, so don't feel bad about saying no to additional projects or responsibilities. Extreme weight loss or gain Talk with your doctor about possible reasons for a dramatic change in weight. They'll work with you to help you manage your weight. Reaction to birth control Hormonal birth control introduces hormones into your body. This can affect your menstrual cycle and cause spotting in between periods. You may need to try a few different types of birth control to find one that works for you. It also takes a few months for your body to adjust to a new method of birth control. Have a discussion with your doctor about what you should expect when starting a new birth control method. Preparing for your doctor's appointment Changes to your menstrual cycle can indicate a health problem, so it's important to discuss abnormal bleeding with your doctor. They will likely ask a lot of questions about your symptoms. By being prepared for your appointment, you can help your doctor find the correct treatment as quickly as possible. Here are some questions your doctor may ask: How long are your cycles? Is this typical for you? If your shorter cycle isn't normal for you, when did the changes to your bleeding start? How long does the bleeding last? What color is the blood? How heavy is the bleeding? How quickly does it fill a pad? Are there clots? If so, how big are they? Do you have any other symptoms? To calculate the length of your cycle, start counting on the first day you bleed. This will be day one. Your cycle will end on the first day that you start bleeding again. Many smartphone apps are available to help you track your cycle. If you have a history of irregular bleeding, tracking your cycles on an app can help you identify a problem more quickly. It can also make it easier to share your cycle information with your doctor. The takeaway In certain situations, such as puberty and perimenopause, having two periods in one month may not be cause for alarm. However, if you're familiar with your cycle and have noted recent changes, or if you just feel like you're bleeding more than you should be, talk with a doctor. They can help get to the bottom of your issue, and if warranted, can help you balance your hormone levels and regulate your bleeding.
Washington Post
an hour ago
- Washington Post
Maine will let abortion-pill prescribers keep their names off labels
Health-care providers in Maine who prescribe abortion pills will be able to remove their names from the medication's label under a new law — the latest example of a Democratic-led state moving to maintain abortion access by protecting doctors, pharmacists and others authorized to dispense mifepristone and misoprostol. The statute allows providers to use their facility's name instead of their own when prescribing these drugs to end pregnancies. Medication is now used in nearly two-thirds of abortions in the United States, supplanting surgical methods. Maine already has a law shielding its abortion providers from punishment in states that ban the procedure. But the new law adds another layer of protection. State Rep. Sally Cluchey (D) sponsored the measure in response to health-care professionals telling lawmakers they feared for their safety. Her bill saw opposition from legislators in both chambers — a clash representative of the nationwide debate over how and where abortion pills can be legally prescribed. Mifepristone itself is at the center of multiple court challenges over medication abortion. And leaders in two conservative states have sought to punish out-of-state doctors who mailed abortion pills into their states, challenging provider 'shield laws' like Maine's and raising concerns about a new frontier of legal consequences. In Maine, abortion providers have faced stalkers, bomb threats and harassing online messages, Cluchey said ahead of the House's vote on the measure. She described the legislation as 'simple but essential' for providers to safely do their jobs. The state allows abortion until viability, around 24 weeks, when the fetus can survive outside the womb. 'It is our responsibility as legislators to ensure that Mainers can engage in lawful work and activities without fear of being targeted, regardless of how we feel personally about those activities,' Cluchey said. After the Supreme Court overturned Roe v. Wade in 2022, the number of women who used abortion pills to end their pregnancies rose significantly. In cases where the pills are obtained by mail, medication abortions bypass direct involvement of a health-care provider — even in states where the procedure is severely restricted. Access to the pills themselves is banned in 17 states, limited in 10 states and legal in D.C. and 23 states, according to The Washington Post's database. The varied state laws on the pills further complicate the post-Roe landscape for abortion access, one that became more confusing for providers when a New York doctor was criminally indicted for allegedly prescribing abortion pills to a girl in Louisiana. The January indictment of physician Margaret Carpenter marked the first time an abortion provider had been prosecuted since Roe fell. Police in Louisiana learned of Carpenter from the medication's package label, which included her name. New York Gov. Kathy Hochul (D) said the state would not comply with Louisiana's warrant to extradite Carpenter. In February, Hochul also signed a measure allowing New York abortion providers to ask pharmacies to list their practice's name on pill labels rather than their own. The Maine legislation, which Gov. Janet Mills (D) signed into law on Thursday, follows that example. Washington state enacted its own measure last year, and Vermont did so last month. During debate in the Maine's Democratic-controlled legislature, some Republicans opposing the measure falsely claimed that mifepristone and other medication abortion drugs were unsafe. They urged that providers' names be required so patients could follow up should they need additional care after administering the pills. 'They should not be dispensed under a veil of secrecy,' said state Rep. Reagan Paul (R). Abortion providers have pushed back against the notion that the new measure compromises patient safety. Pharmacists will know the provider who prescribed the pills, and from them, patients can contact the facility where the provider works to ask questions about care if needed, said Evelyn Kieltyka, the senior vice president of Program Services at Maine Family Planning, which operates reproductive health care clinics. Drug labels in Maine are required to include the name, address and phone number of the pharmacy where the prescription was dispensed. 'There is absolutely no concern that a patient is not getting top notch care,' Kieltyka said. At Maine Family Planning, clinicians prescribe abortion pills only to in-person patients or, in certain cases, via telehealth after confirming that the patient is physically in the state, Kieltyka said. The group's clinics have not received specific threats, but the new law helps comfort both patients and providers in the state, she added. 'It further reassures providers that Maine's got your back,' Kieltyka said.
