The Teaming Curve: A Longitudinal Study of the Influence of Surgical Team Familiarity on Operative Time

OBJECTIVE:To quantify the association between surgical team familiarity and operative time. BACKGROUND:Team familiarity in the operating room may influence outcomes irrespective of individual surgeonsʼ experience. To date, however, quantifying the impact of teamwork on outcomes has been challenging. METHODS:We studied 754 bilateral reduction mammaplasty procedures performed by 223 teams, comprising 8 attending surgeons and 107 assisting surgeons, at a major academic hospital between 1995 and 2007. For each procedure, the operative experience of the attending and assisting surgeons and the number of mammaplasty procedures they had previously performed in collaboration were determined. The influence of these factors on operative time was quantified along with patient age, volume of breast reduction, and comorbidities, using multivariate generalized estimating equations. RESULTS:The mean operative time was 153 (SD = 38) minutes for teams with no prior collaborations, 132 (SD = 33) minutes for teams with 1 to 5 collaborations, 116 (SD = 23) minutes for teams with 6 to 10 collaborations, and 119 (SD = 27) minutes for teams with more than 10 collaborations (P = 0.0001). Operative time was independently associated with the operative experience of the attending (P = 0.02) and assisting surgeons (P = 0.03) and the number of prior collaborations between them (P < 0.001). The expected reductions in operative time over the attending surgeonʼs career and the assisting surgeonʼs training period were 59 and 22 minutes, respectively. Surgical team familiarity accounted for an additional reduction of 16 minutes after 10 prior collaborations. CONCLUSIONS:In addition to individual surgeon experience, team familiarity contributed to reductions in operative time, suggesting potential benefits to maintaining continuity of team membership over time.