Team design as innovation in perioperative care: the case of HPB anesthesiology
Julie Hallet, MD MSC, Naheed Jivraj, MD MSc
Change takes time – in all fields, including surgery. Yet, innovation is highly prized. The latest tools and technologies are celebrated and heavily invested in. But not all improvements require new technology.
For example, robotic pancreatic surgery is being adopted worldwide at a cost of millions in capital investment and ongoing expenses. Evidence shows it is mostly non-inferior to the standard of care.1–4 Another example is histotripsy for liver tumors, which has been rapidly purchased across multiple centers since FDA approval in 2023, spreading like mushrooms after the rain. Evidence is limited to technical feasibility, with no proof of superiority over standard care.5 Both technologies are used only in selected patients. By contrast, high-volume anesthesiology care for hepato-pancreato-biliary (HPB) surgery is associated with15% lower odds of 90-day major morbidity (OR 0.85, 95% CI 0.76–0.94), requires no capital investment, no recurring costs, and applies to all patients.
We are not debating or questioning the benefits of these technologies or the need to invest in new treatments. Rather, we would like to ask: if we are so willing to spend vast sums on new technology, why are we far less inclined to redesign how operative teams are organized?