Does the Position of Surgical Service Providers in Intra-Operative Networks Matter? Analyzing the Impact of Influencing Factors on Patients' Outcome

TL;DR

This study investigates how the position and network structure of surgical providers during operations influence patient outcomes, revealing that provider centrality correlates with fewer complications.

Contribution

It introduces a network analysis approach to intra-operative provider interactions and links network positions to patient outcomes in a large retrospective dataset.

Findings

Highly central providers are associated with fewer complications.

Locally important providers may be linked to higher complications.

Patient age positively correlates with complications.

Abstract

We analyzed the relation between surgical service providers' network structure and surgical team size with patient outcome during the operation. We did correlation analysis to evaluate the associations among the network structure measures in the intra-operative networks of surgical service providers. We focused on intra-operative networks of surgical service providers, in a quaternary-care academic medical center, using retrospective Electronic Medical Record (EMR) data. We used de-identified intra-operative data for adult patients who received nonambulatory/nonobstetric surgery in a main operating room at Shands at the University of Florida between June 1, 2011 and November 1, 2014. The intra-operative dataset contained 30,211 unique surgical cases. To perform the analysis, we created the networks of surgical service providers and calculated several network structure measures at both team and individual levels. We considered number of patients' complications as the target variable and assessed its interrelations with the calculated network measures along with other influencing factors (e.g. surgical team size, type of surgery). Our results confirm the significant role of interactions among surgical providers on patient outcome. In addition, we observed that highly central providers at the global network level are more likely to be associated with a lower number of surgical complications, while locally important providers might be associated with higher number of complications. We also found a positive relation between age of patients and number of complications.