• Xiaohan Xu, Xuerong Yu, Yuelun Zhang, Hongling Chu, Huan Zhang, Xue Zhang, Shuang Ma, Lingeer Wu, Quexuan Cui, Le Shen, and Yuguang Huang.
• Department of Anaesthesiology, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, China.
• Br J Anaesth. 2024 Nov 27.

BackgroundJunior anaesthesiologists often find it difficult to gain the trust of surgeons, possibly because of their limited experience and unfamiliarity with surgeons. Therefore, they can face pressure when navigating disagreements with senior surgeons. We investigated whether and how differences in anaesthesiologist-surgeon seniority might impact patient safety.MethodsThis was a sequential explanatory, mixed-methods evaluation conducted at a general hospital, comprising a retrospective case-control study followed by semi-structured interviews. In the quantitative phase, the case group included surgical patients who experienced anaesthesia-related adverse events. The control group was randomly selected from surgical patients without adverse events, matched to the case group by surgeon, surgery, and surgery year. The exposure was the differences in work experience between anaesthesiologists and surgeons. For the qualitative phase, participants were recruited from attending anaesthesiologists using a theoretical sampling strategy, and a grounded theory analysis was performed.ResultsThe quantitative study included 390 patients in the case group and 1560 patients in the control group. After controlling for confounders, we did not find a significant association between differences in anaesthesiologist-surgeon seniority and odds of anaesthesia-related adverse events (adjusted odds ratio 1.00, 95% confidence interval 0.98-1.01, P=0.634). In cases of disagreements among surgeons, anaesthesiologists primarily based clinical decisions on the potential impact on patient safety. Junior anaesthesiologists faced challenges when rejecting surgeons. Nevertheless, they received robust support from anaesthesiology colleagues.ConclusionsThe capacity of anaesthesiologists to uphold patient safety was not significantly affected by their seniority levels relative to surgeons.Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.

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