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The Impact of Two Operating Surgeons on Microsurgical Breast Reconstruction
Gretl C. Lam, BA1, Katie E. Weichman, MD2, Stelios C. Wilson, MD1, Jamie P. Levine, MD1, Robert J. Allen, MD1, Nolan S. Karp, MD1, Mihye Choi, MD1, Vishal D. Thanik, MD1.
1New York University Langone Medical Center, New York, NY, USA, 2Montefiore Medical Center/Albert Einstein School of Medicine, Bronx, NY, USA.

Purpose: The use of two operating surgeons has been employed in an effort to improve surgical efficiency and outcomes, but its impact is yet unknown. Here we compare the outcomes of patients undergoing microsurgical breast reconstruction with one operating surgeon to those with two surgeons.
Methods: A retrospective review identified all patients undergoing microsurgical breast reconstruction from July 2011 to January 2014 at a single academic institution. Patients were divided into two cohorts – those undergoing reconstruction with one surgeon and those undergoing reconstruction with two surgeons – for analysis of demographics, surgical characteristics and outcomes.
Results: A total of 157 patients underwent 248 breast reconstructions; 103 patients (170 flaps) had two surgeons and 54 patients (78 flaps) had one surgeon. Patients undergoing both bilateral and unilateral reconstructions with two surgeons had significantly decreased mean operating room times and lengths of stay compared to those with one surgeon (Table 1). Additionally, patients with one surgeon were more likely to have postoperative donor site breakdown compared to those with two surgeons (6.4% (n=4) versus 0.6% (n=1), p=0.01).
Conclusion: The collaborative approach of two operating surgeons has demonstrable effects on microsurgical breast reconstruction outcomes. The addition of a second surgeon significantly decreases operating room time and shortens hospital length of stay in both unilateral and bilateral reconstructions. It also significantly decreases donor site wound healing complications.
Table 1: Surgical Characteristics of Bilateral and Unilateral Reconstructions by Number of Surgeons
BILATERAL
CharacteristicSingle SurgeonCo-Surgeonp-value
Number of patients2467N/A
Number of flaps48134N/A
Mean OR time (minutes)*602.9 (117)468.5 (90.1)<0.001
Mean Length of stay (days)*5.4 (2.1)4.1 (1.6)<0.0001
UNILATERAL
CharacteristicSingle SurgeonCo-Surgeonp-value
Number of patients3036N/A
Number of flaps3036N/A
Mean OR time (minutes)*385.9 (126)335.8 (129)0.012
Mean Length of stay (days)*5.5 (3.5)3.7 (1.0)0.004
*reported as: mean (standard deviation)


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