Macke Jamison, Sawaf Tuleen, Schelbar Natalie, Renslo Bryan, Schopper Heather, Sykes Kevin J, Bur Andres, Bond Justin, Shnayder Yelizaveta, Tsue Terance T, Girod Douglas, Kakarala Kiran
University of Kansas School of Medicine, Wichita, Kansas, USA.
University of Kansas School of Medicine, Kansas City, Kansas, USA.
Clin Otolaryngol. 2025 Nov;50(6):981-986. doi: 10.1111/coa.70006. Epub 2025 Jun 27.
To evaluate operative efficiency and quality in head and neck free flap reconstruction with one versus two primary surgeons by comparing procedure duration, hospital length of stay, complications and readmission rates.
Retrospective chart review.
Single-institution tertiary care centre.
A total of 583 patients who received head and neck surgery with free flap reconstruction at the University of Kansas Medical Center between November 2010 and January 2021 were stratified into two cohorts: one-surgeon cohort and two-surgeon cohort. In the two-surgeon cohort, one surgeon performed tissue resection and the second performed reconstruction (n = 329), whereas one primary surgeon performed both resection and reconstruction in the one-surgeon cohort (n = 254). Patient age, sex, American Society of Anaesthesia (ASA) status and Charlson comorbidity index (CCI) at time of surgery were collected.
No significant difference in baseline clinicodemographic characteristics was found between groups. A reduced mean procedure duration was found in the one-surgeon cohort (424.9 min, SD 127.6) compared to the two-surgeon cohort (552.4 min, SD 119.2) (mean difference 127.5 min, Cohen d = 1.04). A slightly greater proportion of osteocutaneous free flaps was performed in the two-surgeon cohort compared to the one-surgeon cohort (one-surgeon: 53.5%; two-surgeon 62.3%). All other secondary quality measures showed nonsignificant differences with the exception of the proportion requiring intraoperative pressors (86.2% in one-surgeon cohort vs. 74.5% in two-surgeon cohort, mean difference 11.7%, Cohen d = 0.29).
This study demonstrates at least noninferior efficiency and quality outcomes in free flap cases led by single primary surgeons at our institution. The optimal approach to maximise operative efficiency and quality likely differs across surgeons and centres.
III.
通过比较手术时间、住院时间、并发症和再入院率，评估由一名主刀医生与两名主刀医生进行头颈部游离皮瓣重建手术的效率和质量。
回顾性病历审查。
单机构三级医疗中心。
2010年11月至2021年1月期间在堪萨斯大学医学中心接受头颈部手术并进行游离皮瓣重建的583例患者被分为两个队列：单主刀医生队列和双主刀医生队列。在双主刀医生队列中，一名医生进行组织切除，另一名医生进行重建（n = 329），而在单主刀医生队列中，一名主刀医生同时进行切除和重建（n = 254）。收集患者手术时的年龄、性别、美国麻醉医师协会（ASA）分级和查尔森合并症指数（CCI）。
两组之间在基线临床人口统计学特征方面未发现显著差异。与双主刀医生队列（552.4分钟，标准差119.2）相比，单主刀医生队列的平均手术时间缩短（424.9分钟，标准差127.6）（平均差异127.5分钟，科恩d值 = 1.04）。与单主刀医生队列相比，双主刀医生队列中进行骨皮游离皮瓣手术的比例略高（单主刀医生队列：53.5%；双主刀医生队列：62.3%）。所有其他次要质量指标均无显著差异，但需要术中使用升压药的比例除外（单主刀医生队列中为86.2%，双主刀医生队列中为74.5%，平均差异11.7%，科恩d值 = 0.29）。
本研究表明，在我们机构中，由单名主刀医生主导的游离皮瓣病例至少具有非劣效的效率和质量结果。最大化手术效率和质量的最佳方法可能因外科医生和中心而异。
III级。
