Do Microsurgical Outcomes Differ Based on Which Specialty Does the Operation? An Analysis of 6,617 Cases from the National Surgical Quality Improvement Program
Jacques X. Zhang, MD, Melissa Wan, BSc, Yichuan Ding, PhD, Yiwen Jin, BSc, Mahesh Nagarajan, MSc, MA, PhD, Marija Bucevska, MD, Douglas J. Courtemanche, MD MS FRCSC, Jugpal Arneja, MD, FRCSC.
University of British Columbia, Vancouver, BC, Canada.
Since plastic surgeons don't "own" a specific anatomical region, increasingly, surgical specialties have assumed procedures historically performed by us. Decreased case volume is postulated to be associated with higher complication rates. Herein we investigate if case volume and surgical specialty has an impact on microsurgical outcomes, specifically SSI, reoperation, and readmission.
The 2005- 2015 NSQIP participant use file was queried by CPT code and stratified by surgical specialty. Multivariate logistic regression was used to compare outcomes between surgical specialties. A subgroup analysis was performed for breast and head/neck microsurgical reconstruction.
NSQIP captured a total of 6,617 microsurgical cases. Of the 4,313 breast reconstructions, 4,127 and 186 were performed by plastic and general surgeons, respectively. Reoperation rates were higher in general surgery (17.7% vs 12.9%, p < 0.001), with a 41.4% higher odds ratio than plastic surgery. Out of the 1,183 head and neck reconstructions, 285 and 898 were performed by plastic surgeons and otolaryngologists, respectively. Reoperation rates were higher in plastic surgery (22.5% vs. 18.9%, p < 0.001), with a 42.7% higher odds ratio than otolaryngology. Reoperation rates decrease with volume of surgeries performed. SSI and re-admission rates between differing specialties were not significantly different.
We demonstrate a specialty-specific correlation between lower volumes and increased complications; once another surgical specialty is adequately trained and amasses enough volume, outcomes can be equivalent if not superior. Plastic surgery is a specialty at risk; we need to protect case breadth and volumes to maintain skills and optimize outcomes.
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