Impact of Greater Surgeon-Anaesthetist Familiarity on Post-Operative Outcomes in Upper Gastrointestinal Cancer...

Background: Greater familiarity between surgeons and anaesthetists is associated with better teamwork and patient safety. We investigated whether the volume of major UGI cancer resections the same surgeon and anaesthetist perform together influences post-operative outcomes at our tertiary specialist cancer centre. Methods: A 10-year retrospective cohort study was conducted via propensity score matching analysis (PSM). Consecutive adults undergoing elective surgical resection for primary UGI carcinoma and colorectal liver metastases from January 2014 to December 2024 were included. Cases were performed by surgeon-anaesthetist dyads composed of five Consultant Surgeons and 34 Consultant Anaesthetists. The primary Consultant Surgeon and Consultant Anaesthetist, the Charlson co-morbidity (CCM) score, and Clavien-Dindo (CD) complications were recorded. Cases were matched for age and CCM score. Results: A total of n = 792 cases were included, which became n = 546 after PSM. The median number of cases performed per dyad was 23, and the median CCM score = 5. Dyads were stratified into high (≥23 cases/dyad) and low volume (<23 cases/dyad), and cases into high (CCM ≥ 5) and low risk (CCM < 5). High-volume dyads had a lower incidence of post-operative complications when adjusted for PSM (35.2%) compared to low-volume dyads (42.8%) (p = 0.829). Probability of CD grade III complications among low-volume dyads increased with a rise in CCM (p = 0.224), but not in high-volume dyads. Conclusions: Greater familiarity between surgeons and anaesthetists may develop by operating on more cases together. This study has highlighted a trend suggesting that high-volume dyads could safely perform UGI resections on higher-risk cases without significant increases in post-operative complications. Dyad volume should be considered in operative scheduling for UGI cancer surgery.