Invited Commentary 

May 28, 2025

Association of Familiarity of the Surgeon-Anesthesiologist Dyad With Major Morbidity After Surgery

Jasmine Hwang, Rachel R. Kelz

JAMA Surg. Published online May 28, 2025. doi:10.1001/jamasurg.2025.1376

We know patients do better when cared for by high-performing teams. Enhanced communication, trust, and experience contribute to the success of effective teams. These attributes are easier to achieve among teammates who are familiar with each other. Specialized areas, like cardiac surgery, have embraced this concept and moved to a model of consistent team assignments to optimize outcomes. However, other specialties might be staffed with whomever is available, leaving patients vulnerable to potential inefficiencies associated with teammates who lack familiarity with each other’s practices.

In their recent article in JAMA Surgery, Hallet et al¹ demonstrate the untoward effects of inconsistent teams on patient outcomes. The study shows that increased surgeon-anesthesiologist dyad familiarity is associated with better postoperative outcomes. These findings extend to both high- and low-risk specialties. These results make coordinated scheduling of consistent surgeon-anesthesiologist dyads (and nurse staffing) an attractive process measure for surgical quality improvement. Institutional interventions creating dedicated intraoperative teams have shown improved patient outcomes, illustrating that theory can become practice.^2,3

Organization of operating room teams impacts not only patient outcomes, but also operating room efficiency. With diminishing margins and increasing production pressures, health care professionals are being asked to do more in shorter periods of time, which could come at a cost to quality and physician well-being.⁴ High-performing teams can decrease operating room time and improve operating room efficiency without negative impacts on patient outcomes.⁵ Surgeon-anesthesiologist pairings and the interactions with the rest of the operating room staff can influence case and turnover length.⁶ Thus, consistent dyads also provide an opportunity to improve operating room efficiency and increase capacity.

So, why not make consistent dyads the norm in operating room scheduling across all specialties? First, coordinating this effort will require change. Change often inspires resistance. However, if we fear change and resist advancement, we will never get better. Second, consistent pairings could threaten physician readiness to work with unfamiliar partners. This is the current state; despite its problems, it should be reasonable to be prepared for unexpected, emergent, or after-hours cases. And, scenario planning and simulation training could be used to ensure physicians and staff are prepared for exceptional cases. Lastly, knowledge of the pairings prior to the day of surgery could result in call outs. At first, this will be difficult to manage; however, once the process becomes the norm, a staff committed to the mission will remain.

Surgical care involves management of the expected and unexpected. Why not minimize the unnecessary angst associated with haphazard staffing and apply that energy to comprehensive, collaborative care? Advanced knowledge of physician dyads and operating room staff assignments will enhance the accuracy of case length estimates, improve operating room efficiency, and deliver better postoperative outcomes.