Zhang Jacques X, Wan Melissa, Ding Yichuan, Jin Yiwen, Nagarajan Mahesh, Courtemanche Douglas J, Bedford Julie, Arneja Jugpal S
Division of Plastic Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Plast Reconstr Surg Glob Open. 2020 Apr 27;8(4):e2769. doi: 10.1097/GOX.0000000000002769. eCollection 2020 Apr.
Because plastic surgeons do not "own" a specific anatomic region, other surgical specialties have increasingly assumed procedures historically performed by plastic surgery. Decreased case volume is postulated to be associated with higher complication rates. Herein, we investigate whether volume and surgical specialty have an impact on microsurgical complications, specifically surgical site infection (SSI) and reoperation rates.
The 2005-2015 National Surgical Quality Improvement Program participant use file was queried by Current Procedural Terminology code for breast and head/neck microsurgeries. Multivariate logistic regression was performed to compare the outcomes between surgical specialties. A cumulative frequency variable was introduced to investigate the effect of case volume on complication rates.
We captured 6,617 microsurgical cases. Multivariate logistic regression revealed that although the rate of SSI was lower in plastic surgery compared with otolaryngology for head and neck reconstructions (13.3% versus 10.5%) and compared with general surgery for breast reconstructions (5.4% versus 4.7%), there was no significant difference between specialties ( = 0.13; = 0.96). Increased case volume is negatively correlated with complications.
Plastic surgery is at risk given case cannibalization by other specialties. We conclude that surgical specialty does not affect the rates of SSI and reoperation. We demonstrate a correlation between lower volumes and increased complications, implying that, once a specialty has amassed critical case experience, complication rates may decrease, and outcomes can be equivalent or superior. Case breadth and volumes should be maintained to preserve skills, optimize outcomes, and maintain the specialty as it currently exists.
由于整形外科医生并不“专属”于特定的解剖区域，其他外科专科越来越多地承担起以往由整形外科实施的手术。据推测，手术量的减少与更高的并发症发生率相关。在此，我们调查手术量和手术专科是否会对显微外科手术并发症产生影响，特别是手术部位感染（SSI）和再次手术率。
通过现行手术操作术语代码查询2005 - 2015年国家外科质量改进计划参与者使用档案中的乳房及头颈部显微外科手术病例。进行多因素逻辑回归分析以比较不同手术专科之间的结果。引入累积频率变量来研究手术量对并发症发生率的影响。
我们收集了6617例显微外科手术病例。多因素逻辑回归分析显示，虽然在头颈部重建手术中，整形外科的SSI发生率低于耳鼻喉科（13.3%对10.5%），在乳房重建手术中低于普通外科（5.4%对4.7%），但各专科之间无显著差异（P = 0.13；P = 0.96）。手术量增加与并发症呈负相关。
鉴于其他专科对病例的蚕食，整形外科面临风险。我们得出结论，手术专科并不影响SSI发生率和再次手术率。我们证明了手术量较低与并发症增加之间的相关性，这意味着，一旦一个专科积累了关键的病例经验，并发症发生率可能会降低，且结果可能相当或更好。应保持病例广度和手术量以保持技能、优化结果并维持该专科的现有状态。
