  We examined the structure of intra- and postoperative case-collaboration
networks among the surgical service providers in a quaternary-care academic
medical center, using retrospective electronic medical record (EMR) data. We
also analyzed the evolution of the network properties over time, as changes in
nodes and edges can affect the network structure. We used de-identified intra-
and postoperative data for adult patients, ages >= 21, who received
nonambulatory/nonobstetric surgery at Shands at the University of Florida
between June 1, 2011 and November 1, 2014. The intraoperative segment contained
30,245 surgical cases, and the postoperative segment considered 30,202
hospitalizations. Our results confirmed the existence of strict small world
structure in both intra- and postoperative surgical team networks. A sudden
declining trend is expected in the future in both intra- and postoperative
networks, since the small world property is currently at its peak. In addition,
high network density was observed in the intraoperative segment and partially
in postoperative one, representing the existence of cohesive clusters of
providers. We also observed that the small world property is exhibited more in
the intraoperative compared to the postoperative network. Analyzing the
temporal aspects of the networks revealed the postoperative segment tends to
lose its cohesiveness as the time passes. Our results highlight the importance
of stability of personnel in key positions. This highlights the important role
of the central players in the network that offers change-leaders the
opportunity to quantify and target those nodes as mediators of process change.
