Division of Plastic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Breast. 2013 Oct;22(5):914-8. doi: 10.1016/j.breast.2013.04.013. Epub 2013 May 11.
Mastectomy with immediate reconstruction requires the coordination and expertise of two distinct surgeons. This often results in several different combinations of mastectomy and reconstructive surgeons, but with an unknown impact on patient outcomes. We evaluate the effect of different surgical teams on complication rates following mastectomy and immediate reconstruction.
Retrospective review of consecutive patients that underwent mastectomy with immediate prosthetic reconstruction from 4/1998 to 10/2008 at one institution was performed. Patients of the three highest-volume mastectomy and reconstructive surgeons were stratified by their individual combination of surgeons, resulting in nine different surgical teams. Complications were categorized by end-outcome. Appropriate statistics, including multiple linear regression, were performed.
Clinical characteristics were similar among patients (n = 511 patients, 699 breasts) with the same mastectomy surgeon but different reconstructive surgeon. Mean follow-up was 38.4 ± 25.7 months. For each mastectomy surgeon, the choice of reconstructive surgeon did not affect complication rates. Furthermore, the combined complication rates of the three highest-volume teams (n = 384 breasts) were similar to the remaining lower-volume teams (n = 315 breasts). Patient factors, but not the individual surgeon or surgical team, were independent risk factors for complications.
Our study suggests that among high-volume surgeons, complication rates following mastectomy with immediate reconstruction are not affected by the surgeon-surgeon familiarity. The individual surgeon's expertise, and patient risk factors, may have a greater impact on outcomes than the team's experience with each other. These results validate the efficacy and safety of the surgeon distribution model currently used by many breast surgery practices.
乳房切除术和即刻重建需要两位不同的外科医生的协调和专业知识。这通常会导致乳房切除术和重建外科医生的几种不同组合，但对患者的结果影响未知。我们评估了不同手术团队对乳房切除术和即刻重建后并发症发生率的影响。
对一家机构 1998 年 4 月至 2008 年 10 月期间接受乳房切除术和即刻假体重建的连续患者进行回顾性研究。根据每位外科医生的个人手术团队组合，将三位最高手术量的乳房切除术和重建外科医生的患者分层，共分为九个不同的手术团队。并发症按最终结果进行分类。进行了适当的统计分析，包括多元线性回归。
具有相同乳房切除术外科医生但不同重建外科医生的患者（n = 511 例，699 侧乳房）的临床特征相似。平均随访时间为 38.4 ± 25.7 个月。对于每位乳房切除术外科医生，重建外科医生的选择并不影响并发症发生率。此外，三个最高手术量团队（n = 384 侧乳房）的综合并发症发生率与其他较低手术量团队（n = 315 侧乳房）相似。患者因素，而不是单个外科医生或手术团队，是并发症的独立危险因素。
我们的研究表明，在高手术量的外科医生中，乳房切除术和即刻重建后的并发症发生率不受外科医生之间熟悉程度的影响。外科医生的专业知识以及患者的风险因素可能对结果的影响大于团队之间的经验。这些结果验证了许多乳房外科手术实践目前使用的外科医生分配模型的有效性和安全性。
