title: Can the impact of change of surgical teams in cardiovascular surgery be measured by operative mortality or morbidity? A propensity adjusted cohort comparison.
abstract: OBJECTIVE
  Our objective was to examine the impact of team changeover and unfamiliar teams in cardiovascular surgery on traditional clinical outcome measures.
  
  
  BACKGROUND
  The importance of teamwork in the operating room is increasingly being appreciated, but the impact on more traditional outcome measures is unclear.
  
  
  METHODS
  Elective or urgent cardiovascular procedures were divided into categories: team D (patients who had an operation with a day team); team E (patients who had an operation with an evening team); team C (patients who had an operation which included changeover between a day and evening team). Comparison groups were adjusted using propensity scores.
  
  
  RESULTS
  We identified 6698 patients who met inclusion criteria (team D, n =3781; team E, n = 518; team C, n = 2399). After propensity score adjustment,there was an increased skin–skin time of 28 minutes in team C when compared with team D (P < 0.001) and of 21 minutes when compared with team E (P <0.001). There were also more episodes of septicemia among team C patients(OR 1.85, P = 0.013) when compared with team D. Patients operated by a day team had a statistically significantly lower number of ventilated hours and shorter hospital length of stay when compared with team E and team C (P < 0.001 and P < 0.001, respectively). There was no difference between teams in operative death, reoperation for bleeding, blood transfusion, renal failure/dialysis, neurologic events, or deep/superficial wound infections.
  
  
  CONCLUSIONS
  The change in operating room personnel from the day team to the evening team added significant length to the total operating department time in cardiovascular surgery; however, its impact on most traditional outcome measures was difficult to demonstrate. More sensitive outcome measures may be required to assess the impact of teamwork interventions.
authors.affiliation: Division of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, AB, Canada.
authors.forename: Morgan L
authors.initials: ML
authors.lastname: Brown
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Parker
authors.forename: Luis G
authors.initials: LG
authors.lastname: Quiñonez
authors.forename: Zhuo
authors.initials: Z
authors.lastname: Li
authors.forename: Thoralf M
authors.initials: TM
authors.lastname: Sundt
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality*; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000401:mortality; D005260:Female; D006351:Heart Valves / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009873:Operating Rooms / Q000458:organization & administration; D010348:Patient Care Team / Q000458:organization & administration*; D010561:Personnel Staffing and Scheduling; D011183:Postoperative Complications; D011785:Quality Assurance, Health Care; D013997:Time Factors; D016896:Treatment Outcome