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
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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%). 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引用次数: 0
摘要
目的：通过对手术时间、住院时间、并发症及再入院率的比较，评价1位主刀医师与2位主刀医师头颈部游离皮瓣重建的手术效果和质量。研究设计：回顾性图表回顾。环境：单一机构三级医疗中心。方法：将2010年11月至2021年1月在堪萨斯大学医学中心接受头颈部手术游离皮瓣重建的583例患者分为两组：单外科医生队列和双外科医生队列。在两名外科医生的队列中，一名外科医生进行了组织切除，另一名进行了重建（n = 329），而在一名外科医生的队列中，一名主要外科医生同时进行了切除和重建（n = 254）。收集患者手术时的年龄、性别、美国麻醉学会（ASA）状态和Charlson合并症指数（CCI）。结果：两组间基线临床人口学特征无显著差异。与两名外科医生组（552.4 min, SD 119.2）相比，一名外科医生组的平均手术时间缩短（424.9 min, SD 127.6）（平均差127.5 min, Cohen d = 1.04）。与单外科医生组相比，双外科医生组的骨皮游离皮瓣的实施比例略高(单外科医生组：53.5%；为62.3%)。除术中使用降压药的比例（单外科医生队列为86.2%，双外科医生队列为74.5%，平均差11.7%,Cohen d = 0.29）外，其他所有次要质量指标均无显著差异。结论：本研究表明，在我院由单个主刀医师主导的游离皮瓣病例中，至少具有良好的疗效和质量。最大限度提高手术效率和质量的最佳方法可能因外科医生和中心而异。证据水平：III。
Outcomes of Microvascular Free Flap Reconstruction With One Versus Two Primary Surgeons.
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.
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