Comparison of surgical outcomes of free flap reconstructions performed by expert microsurgeons and trainees who completed a structured microsurgical training program in a teaching hospital

Park, Jin Woo; Moon, Jeehyun; Lee, Kyeong Tae; Woo, Kyong Je; Oh, Han-Mo; Jeon, Byung Joon; Lim, So Young; Pyon, Jai Kyong; Mun, Goo‐Hyun

doi:10.1016/j.bjps.2020.05.036

Cited by 6 publications

(7 citation statements)

References 24 publications

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“…Após o término da cobertura, é comum que os pacientes solicitem procedimentos de rebaixamento de retalho, principalmente nos membros inferiores, para um aspecto mais estético. Estudos prévios não mostram alterações da morbidade na área doadora, mesmo em casos de reconstruções oncológicas [18][19][20] . Em nossa experiência, os retalhos para os membros inferiores na região maleolar apresentam maior taxa de solicitação de rebaixamento do retalho, apresentando uma tendência (Teste do Qui-Quadrado, p=0,099) para retalhos anterolaterais da coxa e grande dorsais, que são utilizados em falhas maiores de fraturas expostas do terço distal da perna, e apresentam uma altura maior quando comparados a retalhos menores.…”

Section: Discussionunclassified

Experiência de um Hospital Terciário com Falhas de Cobertura e seu Tratamento com Retalhos Livres e Rotacionais

et al. 2023

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Introdução: A cobertura de falhas cutâneas com retalhos livres e rotacionais é uma proposta estabelecida de tratamento, principalmente com o aumento da capacidade técnica e de instrumentais. Existe uma grande variedade de retalhos descritos, e apesar do esforço para reduzir os erros de técnica, as taxas de complicações ainda são altas. Estas complicações dependem de fatores inerentes ao paciente, à cirurgia e ao manejo pós-operatório. Este estudo propõe elucidar a população submetida a tratamento de falha de cobertura com retalhos livres, rotacionais e de avanço, tal como a taxa de complicação e necessidade de reabordagem. Métodos: Estudo retrospectivo baseado em dados de prontuário de pacientes submetidos a tratamento cirúrgico de falha de cobertura com retalhos livres e rotacionais no período de janeiro de 2015 a dezembro de 2021 em um hospital terciário. Resultados: A taxa de reoperação global foi de 68,8%, sendo 85,7% nos retalhos livres e 57,8% nos retalhos de rotação (p<0,001), com diferença estatística para tempo de internação (p=0,001) e tempo cirúrgico (p<0,001), sem diferença para tamanho da falha (p=0,458). A taxa de falha global dos retalhos foi de 16,9%, sendo 23,8% nos retalhos livres e 12,5% nos retalhos de rotação (p=0,032). A falha do retalho apresentou diferença estatística para o tamanho da falha (p=0,004), tempo cirúrgico (p=0,040) e tempo de internação em dias (p=0,015). Conclusão: a taxa de falha dos retalhos e de reoperação são consistentes com os dados da literatura. As comorbidades podem ser controladas por equipes multidisciplinares de forma a não influenciarem no resultado pós-operatório.

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Section: Discussionunclassified

Experiência de um Hospital Terciário com Falhas de Cobertura e seu Tratamento com Retalhos Livres e Rotacionais

et al. 2023

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“…Prior studies often compared outcomes between surgeries performed by skilled staff surgeons vs . those by trainees [ 5 , 34 ]. The strength of our study is, thereby, the use of objective measures to evaluate outcomes using the coronal flap as a part of CMF injury patient care to argue for or against the “surgical sub-unit” learning concept.…”

Section: Discussionmentioning

confidence: 99%

“…Third, high volume of CMF injuries could increase trainees’ skills and success rate of the surgery, albeit performed by novice trainees. Accumulation of clinical experience at hospitals with high patient volume, taught by a skilled, qualified surgeon, may reduce the learning curve in surgery, and probably, interfere the study’s generalization or external validity especially in a small trainee cohort (n = 5 in each study arm) [ 5 ]. Fourth, the post hoc power based on CFRCs was < 50%, suggesting the high possibility of the beta error.…”

Section: Discussionmentioning

confidence: 99%

“…If the findings of this study favored the outcomes in the OMFS/CFPS-Rs group, the surgical “sub-step” education based on the above-mentioned integrative model of CMF surgeons in trauma units should be terminated, i.e., the coronal flap (and probably, any other “sub-steps”) ought to be performed by CMF surgeons or OMFS/CFPS-Rs only. We supposed that adequate basic knowledge, with exposure to a high volume of CMF trauma could help trainees perform their own sub-steps during the training period with favorable outcomes [ 5 ]. The specific aims were 1) to identify a sample of coronal flaps elevated by OMFS/CFPS-Rs and TS-Rs, 2) to document the type and frequency of CFRCs, and 3) to compare treatment outcomes between the trainee groups.…”

Section: Introductionmentioning

confidence: 99%

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Does Training Background Influence Outcomes after Coronal Scalp Incision for Treating Craniomaxillofacial Injuries?: A German Pilot Study

Pitak‐Arnnop

Subbalekha

Tangmanee

et al. 2023

J. Maxillofac. Oral Surg.

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Objectives To examine outcomes of the coronal scalp approach to craniomaxillofacial (CMF) fractures performed by oral-maxillofacial or craniofacial plastic surgery residents (OMFS/CFPS-Rs) vs. trauma surgery residents (TS-Rs), and to determine differences in treatment outcomes between both operator groups. Methods This retrospective cohort study enrolled a sample of CMF fracture adult patients treated via the coronal approach in a German level one trauma center during a two-year interval. The predictor variable was training background (OMFS/CFPS-Rs vs. TS-Rs; each n = 5). All trainees must assist in ≥ two surgeries before self-performance. The main outcomes were length of hospital stay (LHS) and coronal flap-related complications (CFRCs). Appropriate statistics were computed at α = 95%. Results Of the 97 patients identified during the study period; 71 of whom (19.7% females; mean age, 40.2 ± 15.2 years; 46.5% operated by TS-Rs; 38% combined upper and midfacial fractures) met the inclusion criteria. Operative time, LHS, CFRCs, readmission rates, and post-discharge emergency room visits were not significantly different between the trainee groups. 60% of CFRCs were visible/unfavorable or hypertrophic scar with/without alopecia. The number needed to treat of short LHS was 44 (95% confidence interval [CI], 3.9 to 4.8), the number needed to harm of CFRCs was 14 (95% CI, 3.6 to 7.4), i.e., the likelihood to be helped or harmed was 0.32. Conclusions Coronal flap raising by OMFS/CFPS-Rs does not appear beneficial over that by TS-Rs in terms of LHS and CFRCs evaluated until postoperative month six. Trainees from any surgical specialties could gain partial independence from skilled surgeons in CMF trauma “sub-steps” and favorable clinical outcomes. Further studies in a larger sample cohort are required to confirm this pilot data.

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“…Wenn diese Kennzahlen im Krankenhausbetriebssystem hinterlegt werden, besteht die Möglichkeit OP-Kapazitäten anhand des Erfahrungsniveaus des OP-Teams zu planen. In einer Studie aus Korea wurden ebenfalls SNZ zwischen fortgeschrittenen Assistenzärzten und Experten in der Mikrochirurgie verglichen [19]. Bei insgesamt 161 Patienten zeigten sich ähnliche Komplikationsraten, wenngleich die SNZ bei Experten signifikant kürzer waren.…”

Section: Benchmarking Mit Anderen Klinikenunclassified

Analyse der Effizienz, Kostenstruktur und Erlössituation von freien ALT-Lappenplastiken zur Extremitätenrekonstruktion

Behr

Schlüchtermann

Radtke

et al. 2022

Handchir Mikrochir Plast Chir

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ZusammenfassungEinleitung Der freie Transfer einer Gewebelappenplastik mit mikrochirurgischem Anschluss ist häufig eine tagesauslastende Tätigkeit. Eine Standardisierung dieser Operationen gestaltet sich auf Grund der eingeschränkten Planbarkeit des OP-Verlaufs mit einhergehender zeitlicher Varianz immer wieder als schwierig. Dies erschwert die Planung und damit die optimale Kapazitätsauslastung erheblich. Methoden In den Jahren 2018–2020 wurden die Schnitt-Naht-Zeiten (SNZ) bei den in der Klinik am häufigsten durchgeführten freien ALT-Lappenplastiken zur Extremitätenrekonstruktion bezogen auf das Erfahrungsniveau des Operationsteams (Kategorie 1:<50 freie Lappenplastiken, Kategorie 2: 50–200 freie Lappenplastiken, Kategorie 3:>200 freie Lappenplastiken) und die Nebenerkrankungen der Patienten analysiert. Die Kostenstruktur am Standort wurde mit der InEK Kostenmatrix abgeglichen.Ergebnisse In der vorliegenden Arbeit konnte gezeigt werden, dass im Rahmen der mikrochirurgischen Extremitätenrekonstruktion das Erfahrungsniveau des Operationsteams einen signifikanten Einfluss auf die SNZ hat. Bei ALT-Lappenplastiken waren unter Berücksichtigung von Komplikationen Kategorie 2 Operateure durchschnittlich 45 Minuten, Kategorie 3 Operateure 167 Minuten schneller. Umgekehrt hatten Nebenerkrankungen keinen signifikanten Einfluss auf die Operationsdauer. Bezogen auf die Kostensituation zeigte sich eine zumeist defizitäre Situation in Relation zur InEK Kostenmatrix. Eine weitere Analyse zeigte hingegen, dass die SNZ für freie Lappenplastiken im Durchschnitt, die Personalkosten/Schnitt-Naht-Minute unseres Krankenhauses knapp unter dem Bundesdurchschnitt lagen. Die Kosten für einen mikrochirurgischen Weiterbildungseingriff liegen nach dieser Berechnung in der Größenordnung von 1000 €/Fall. Diskussion & Schlussfolgerung Freie Lappenplastiken zur Extremitätenrekonstruktion sind nicht komplett adäquat im deutschen DRG-System abgebildet. Bezogen auf die Weiterbildung konnte gezeigt werden, dass diese bedingt durch längere SNZ nicht kostenneutral ist. Durch Hinterlegung der identifizierten operateurbedingten Zeiten im Krankenhausinformationssystem sollte eine bessere Vorgabezeitgüte mit aufgewerteter Termintreue und effizienterer Auslastung der wertvollen Ressource OP-Kapazität resultieren.

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Comparison of surgical outcomes of free flap reconstructions performed by expert microsurgeons and trainees who completed a structured microsurgical training program in a teaching hospital

Cited by 6 publications

References 24 publications

Experiência de um Hospital Terciário com Falhas de Cobertura e seu Tratamento com Retalhos Livres e Rotacionais

Experiência de um Hospital Terciário com Falhas de Cobertura e seu Tratamento com Retalhos Livres e Rotacionais

Does Training Background Influence Outcomes after Coronal Scalp Incision for Treating Craniomaxillofacial Injuries?: A German Pilot Study

Analyse der Effizienz, Kostenstruktur und Erlössituation von freien ALT-Lappenplastiken zur Extremitätenrekonstruktion

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