Evaluating the Effect of Time-Based Surgeon-Team Familiarity on Neurosurgery Outcomes.

BACKGROUND AND OBJECTIVES: Surgeon-team familiarity is a critical factor that affects surgical outcomes. The relationships between familiarity and surgical outcomes are varied, and an operational definition of this measure remains underdeveloped. This study creates an effective time-based measure of surgeon-team familiarity and assesses its association with clinical and operational outcomes for neurosurgery. METHODS: Retrospective analysis of 9049 neurosurgery cases performed at 2 campuses of a tertiary academic medical center over a 3-year timeframe was conducted. This study measures normalized case duration as a proxy for operational performance and 30-day postoperative complications for clinical outcomes. Multivariate linear regression and logistic regression were used to analyze relationships between surgeon-team familiarity and surgical outcomes, with risk factors as control variables for case mix. RESULTS: For normalized case duration, the coefficient of surgeon-team familiarity is negative (β = -0.015, P = .03), but the squared term exhibits a positive relationship (β = 0.049, P = .003). The overall regression is statistically significant (R 2 = 0.046, adjusted R 2 = 0.045, P < .001). The logistic regression shows that surgeon-team familiarity scores are negatively correlated (odds ratio = 0.356, 95% CI [0.126, 0.987]) with the risks of postoperative complications. It is statistically significant and explains between 2.4% (Cox & Snell R Square) and 6.0% (Nagelkerke R Square) of the variance for postoperative complications. CONCLUSION: This study found that surgeon-team familiarity is positively associated with neurosurgery outcomes. Teams familiar with the surgeons will likely improve operational performance and reduce the risk of postoperative complications, whereas too much familiarity may lengthen the case duration. Surgical practice leaders can use electronic health record data to define appropriate familiarity scores and incorporate key metrics when developing surgical team assignments for optimal operating room performance.