Jamison Macke, Tuleen Sawaf, Natalie Schelbar, Bryan Renslo, Heather Schopper, Kevin J Sykes, Andres Bur, Justin Bond, Yelizaveta Shnayder, Terance T Tsue, Douglas Girod, Kiran Kakarala
{"title":"Outcomes of Microvascular Free Flap Reconstruction With One Versus Two Primary Surgeons.","authors":"Jamison Macke, Tuleen Sawaf, Natalie Schelbar, Bryan Renslo, Heather Schopper, Kevin J Sykes, Andres Bur, Justin Bond, Yelizaveta Shnayder, Terance T Tsue, Douglas Girod, Kiran Kakarala","doi":"10.1111/coa.70006","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Study design: </strong>Retrospective chart review.</p><p><strong>Setting: </strong>Single-institution tertiary care centre.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":10431,"journal":{"name":"Clinical Otolaryngology","volume":" ","pages":""},"PeriodicalIF":1.5000,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Otolaryngology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/coa.70006","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"OTORHINOLARYNGOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: 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.
Study design: Retrospective chart review.
Setting: Single-institution tertiary care centre.
Methods: 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.
Results: 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).
Conclusions: 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.
期刊介绍:
Clinical Otolaryngology is a bimonthly journal devoted to clinically-oriented research papers of the highest scientific standards dealing with:
current otorhinolaryngological practice
audiology, otology, balance, rhinology, larynx, voice and paediatric ORL
head and neck oncology
head and neck plastic and reconstructive surgery
continuing medical education and ORL training
The emphasis is on high quality new work in the clinical field and on fresh, original research.
Each issue begins with an editorial expressing the personal opinions of an individual with a particular knowledge of a chosen subject. The main body of each issue is then devoted to original papers carrying important results for those working in the field. In addition, topical review articles are published discussing a particular subject in depth, including not only the opinions of the author but also any controversies surrounding the subject.
• Negative/null results
In order for research to advance, negative results, which often make a valuable contribution to the field, should be published. However, articles containing negative or null results are frequently not considered for publication or rejected by journals. We welcome papers of this kind, where appropriate and valid power calculations are included that give confidence that a negative result can be relied upon.