Do not break up the surgical team! Familiarity and expertise affect operative time in complex surgery

Background: The effects of replacing a surgeon's familiar, experienced certified surgical assistant (CSA) on perioperative outcomes in complex surgery were investigated. Methods: An interrupted time series of totally laparoscopic pancreatoduodenectomies performed by a single surgeon was retrospectively studied. Segmented regression analysis estimated replacement effects on estimated blood loss (EBL) and operative time. Results: The cohort was composed of the last 100 cases with the familiar CSA and the first 100 cases with the replacement CSA. Study groups were similar. Unadjusted segmented regression of operative time and EBL predicted replacement effects of 70 min (95%CI, 18–122; p = 0.008) and 114 cc (95%CI, -93-320; p = 0.3), respectively. Adjusted regression predicted replacement effects of 40 min (95%CI, 0.9–78; p = 0.04) and 27 cc (95%CI, -156-210; p = 0.3). Conclusions: The replacement of a familiar, experienced CSA was associated with longer operative times. Despite confinement to a single surgeon and procedure, these results suggest what all surgeons know: excellent help is priceless.