title: Impact of team familiarity in the operating room on surgical complications.
abstract: BACKGROUND
  The quality of surgical performance depends on the technical skills of the surgical team as well as on non-technical skills, including teamwork. The present study evaluated the impact of familiarity among members of the surgical team on morbidity in patients undergoing elective open abdominal surgery.
  
  
  METHODS
  A retrospective analysis was performed to compare the surgical outcomes of patients who underwent major abdominal operations between the first month (period I) and the last month (period II) of a 6-month period of continuous teamwork (stable dyads of one senior and one junior surgeon formed every 6 months). Of 117 patients, 59 and 58 patients underwent operations during period I and period II, respectively, between January 2010 and June 2012. Team performance was assessed via questionnaire by specialized work psychologists; in addition, intraoperative sound levels were measured.
  
  
  RESULTS
  The incidence of overall complications was significantly higher in period I than in period II (54.2 vs. 34.5 %; P = 0.041). Postoperative complications grade <3 were significantly more frequently diagnosed in patients who had operations during period I (39.0 vs. 15.5 %; P = 0.007), whereas no between-group differences in grade ≥3 complications were found (15.3 vs. 19.0 %; P = 0.807). Concentration scores from senior surgeons were significantly higher in period II than in period I (P = 0.033). Sound levels during the middle third part of the operations were significantly higher in period I (median above the baseline 8.85 dB [range 4.5-11.3 dB] vs. 7.17 dB [5.24-9.43 dB]; P < 0.001).
  
  
  CONCLUSIONS
  Team familiarity improves team performance and reduces morbidity in patients undergoing abdominal surgery.
authors.affiliation: Department of Visceral Surgery and Medicine, Inselspital University Hospital Bern and University Bern, 3010, Bern, Switzerland, anita.kurmann@insel.ch.
authors.forename: A
authors.initials: A
authors.lastname: Kurmann
authors.forename: S
authors.initials: S
authors.lastname: Keller
authors.forename: F
authors.initials: F
authors.lastname: Tschan-Semmer
authors.forename: J
authors.initials: J
authors.lastname: Seelandt
authors.forename: N K
authors.initials: NK
authors.lastname: Semmer
authors.forename: D
authors.initials: D
authors.lastname: Candinas
authors.forename: G
authors.initials: G
authors.lastname: Beldi
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures / Q000592:standards*; D001288:Attention; D017558:Elective Surgical Procedures / Q000592:standards; D005260:Female; D006801:Humans; D015994:Incidence; D007400:Interprofessional Relations; D008297:Male; D008875:Middle Aged; D009873:Operating Rooms; D010348:Patient Care Team / Q000592:standards*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013016:Sound; D055815:Young Adult