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We examined the structure of intra- and postoperative case-collaborationnetworks among the surgical service providers in a quaternary-care academicmedical center, using retrospective electronic medical record (EMR) data. Wealso analyzed the evolution of the network properties over time, as changes innodes and edges can affect the network structure. We used de-identified intra-and postoperative data for adult patients, ages >= 21, who receivednonambulatory/nonobstetric surgery at Shands at the University of Floridabetween June 1, 2011 and November 1, 2014. The intraoperative segment contained30,245 surgical cases, and the postoperative segment considered 30,202hospitalizations. Our results confirmed the existence of strict small worldstructure in both intra- and postoperative surgical team networks. A suddendeclining trend is expected in the future in both intra- and postoperativenetworks, since the small world property is currently at its peak. In addition,high network density was observed in the intraoperative segment and partiallyin postoperative one, representing the existence of cohesive clusters ofproviders. We also observed that the small world property is exhibited more inthe intraoperative compared to the postoperative network. Analyzing thetemporal aspects of the networks revealed the postoperative segment tends tolose its cohesiveness as the time passes. Our results highlight the importanceof stability of personnel in key positions. This highlights the important roleof the central players in the network that offers change-leaders theopportunity to quantify and target those nodes as mediators of process change.

A Quest for the Structure of Intra- and Postoperative Surgical Team Networks: Does the Small World Property Evolve over Time?