Impact of Continuous Two-Team Approach in Autologous Breast Reconstruction

Abstract

Autologous breast reconstruction has been noted in the literature to provide superior aesthetic outcomes and patient satisfaction. Additionally, free perforator flap tissue transfer has the potential for lower abdominal donor site morbidity. However, it has been noted that the percentage of women who are undergoing autologous breast reconstruction in the United States is decreasing. Factors related to the technical difficulty, prolonged operative times, and decreasing reimbursement have been implicated as the causes. A retrospective review of electronic medical records over a 5-year period was performed with evaluation of 77 autologous breast reconstructions at a single institution. Patient demographics, comorbidities, number of surgeons involved, operative times, length of stay, and postoperative complications were measured. Wilcoxon rank-sum, Pearson's chi-squared, and proportional odds likelihood ratio tests were performed to compare continuous, categorical, and ordinal outcomes, respectively. Propensity score weighting was used to adjust for presurgical covariates and laterality. Operative time and length of stay were both significantly lower in the two- versus the single-microsurgeon groups in the unadjusted setting. When covariates and laterality were adjusted for, operative times still remained significantly shorter in the two-microsurgeon group; there were no differences in complications. Based on our findings, we propose that the two-microsurgeon approach can be utilized in more time-consuming microsurgical cases, such as autologous breast reconstruction, to safely decrease operative times and potentially alleviate surgeon fatigue, reduce operative costs, and thus increase overall surgeon productivity.

Assessing the Influence of Attending Surgeon Continuity on Free Flap Outcomes Following Unplanned Returns to the Operating Room

“…A study has demonstrated co-surgeon approach safely decreases operative times and reduces physician fatigue and burnout. 17 This study also demonstrated that take-back procedures performed during the weekend by a covering surgeon are associated with a higher rate of flap loss. This "weekend effect" is inconclusive in the literature.…”

Bilateral mastectomy operations and the role for the cosurgeon technique: A Nationwide analysis of surgical practice patterns

“…While implementation of the CST remains low (14.1%, n = 76), almost one‐third of nonusers expressed interest in future use (31.1%, n = 145), citing potential time and cost savings, as well as the opportunity for mentorship and learning new techniques. In other surgical areas, reports of cosurgeon approaches for complex and/or bilateral procedures describe benefits of time‐ and cost‐savings, improved efficiency, reduced complications, decreased fatigue/burnout, and decreased blood loss/transfusion rates …”

“…In other surgical areas, reports of cosurgeon approaches for complex and/or bilateral procedures describe benefits of time-and cost-savings, improved efficiency, reduced complications, decreased fatigue/burnout, and decreased blood loss/transfusion rates. [9][10][11][12] Reimbursement for cosurgeon surgeries is often less than 100% for the second surgeon. At our institution, second surgeon reimbursement from BM cases is 60%-80% of the primary surgeon reimbursement.…”

The Impact of the Cosurgeon Model on Bilateral Autologous Breast Reconstruction

“…Two studies, which included a mixed cohort of unilateral and bilateral MBRs showed reduced operative times, but were inconclusive about the impact of the CSs on complications perhaps because of a small sample size (i.e., underpowered). 15,16 A study from Sweden, which looked only at unilateral delayed breast reconstructions demonstrated a reduction in OR time but had an incomplete evaluation of postoperative complications. 14 Other surgical specialties have evaluated the CSM for lengthy and/or technically demanding procedures with similar benefits.…”

“…[9][10][11][12][13] This topic has also been explored in delayed breast reconstructions and a mixed cohort of unilateral/bilateral mastectomies. [14][15][16] The aim of the current study is to evaluate the impact of the CSM specifically on bilateral microsurgical breast reconstruction (MBR). The hypothesis is CS compared with single surgeon (SS) procedures reduces operative time and surgical complications.…”