Razdan Shantanu N, Panchal Hina J, Hespe Geoffrey E, Disa Joseph J, McCarthy Colleen M, Allen Robert J, Dayan Joseph H, Pusic Andrea, Mehrara Babak, Cordeiro Peter G, Matros Evan
Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
J Reconstr Microsurg. 2017 Nov;33(9):624-629. doi: 10.1055/s-0037-1604106. Epub 2017 Jul 31.
Microsurgical breast reconstructions (MBRs) are time and labor intensive procedures. To circumvent these barriers, plastic surgeons have started working together as cosurgeons (CSs). This study aims to evaluate the impact of the CS model (CSM) specifically on bilateral MBR. The hypothesis is that CS procedures reduce operative time and surgical complications.
This was a single institutional retrospective cohort study, which included all consecutive patients who underwent bilateral MBR from 2014 to 2016. Patients were grouped into single surgeon (SS) or CSs based on the number of the attending plastic surgeons present. Demographic and clinical characteristics including age, body mass index, smoking, American Society of Anesthesiologist class, radiation, and the timing of the reconstruction were assessed. Univariate and multivariate analyses were performed for outcomes including operative time and postoperative complications.
Of the 136 patients included in the study, 41% had breast reconstruction performed by CSs, whereas 59% had a SS. Sociodemographic features were evenly distributed with the exception of a greater number of delayed reconstructions in the SS group (33 vs. 13%; <0.01). Pedicle TRAMS (transverse rectus abdominis musculocutaneous flaps) were performed in 5 versus 0% of SS versus CS cases, respectively. Rates of major (4 vs. 16%) and minor (11 vs. 24%) complications were significantly lower in CS procedures. Multivariate analyses demonstrated CS operations required significantly shorter operative time by 73 minutes ( <0.001), and trended toward a reduced postoperative complication rate ( 0.07).
The CSM is associated with improved operative efficiency for bilateral MBR. Further evaluation of the CSM may prove useful in other surgical disciplines with time and labor intense procedures.
显微外科乳房重建术（MBR）是耗时且费力的手术。为了克服这些障碍，整形外科医生开始作为联合外科医生（CS）共同开展手术。本研究旨在评估联合外科医生模式（CSM）对双侧MBR的具体影响。假设是联合外科医生手术可减少手术时间和手术并发症。
这是一项单机构回顾性队列研究，纳入了2014年至2016年期间所有连续接受双侧MBR的患者。根据主刀整形外科医生的数量，将患者分为单外科医生（SS）组或联合外科医生组。评估了人口统计学和临床特征，包括年龄、体重指数、吸烟情况、美国麻醉医师协会分级、放疗以及重建时间。对包括手术时间和术后并发症在内的结果进行了单因素和多因素分析。
在纳入研究的136例患者中，41%接受了联合外科医生手术，而59%接受了单外科医生手术。社会人口学特征分布均匀，但单外科医生组延迟重建的患者数量更多（33%对13%；<0.01）。分别有5%和0%的单外科医生组和联合外科医生组患者接受了带蒂腹直肌肌皮瓣（TRAM）手术。联合外科医生手术的严重（4%对16%）和轻微（11%对24%）并发症发生率显著更低。多因素分析表明，联合外科医生手术所需的手术时间显著缩短73分钟（<0.001），且术后并发症发生率有降低趋势（P = 0.07）。
CSM与双侧MBR手术效率的提高相关。对CSM的进一步评估可能在其他耗时且费力的外科领域中证明是有用的。
