Co-surgery in head and neck microvascular reconstruction

Sophia Dang; Katerina Green; Matthew Bottegal; Nayel I Khan; Mario G Solari; Shaum S Sridharan; Mark W Kubik

doi:10.1016/j.amjoto.2023.104062

Co-surgery in head and neck microvascular reconstruction

Am J Otolaryngol. 2024 Jan-Feb;45(1):104062. doi: 10.1016/j.amjoto.2023.104062. Epub 2023 Sep 22.

Authors

Sophia Dang¹, Katerina Green¹, Matthew Bottegal², Nayel I Khan³, Mario G Solari⁴, Shaum S Sridharan⁵, Mark W Kubik⁶

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
² Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States; Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
³ Department of Otolayrngology-Head and Neck Surgery, Thomas Jefferson University Hospitals, Philadelphia, PA, United States.
⁴ Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States; University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.
⁵ Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States; University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.
⁶ Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States; University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States. Electronic address: kubikmw2@upmc.edu.

PMID: 37769506
DOI: 10.1016/j.amjoto.2023.104062

Abstract

Purpose: Co-surgery with two attending reconstructive surgeons is becoming increasingly common in breast microvascular reconstruction due to case complexity and the potential for improved outcomes and operative efficiency. The impact of co-surgery on outcomes in head and neck microvascular reconstruction has not been studied.

Methods: Our multidisciplinary head and neck reconstruction team (Otolaryngology, Plastic Surgery) at the University of Pittsburgh transitioned to a practice of co-surgery on head and neck free flaps. In this study, we compare outcomes of two surgeon head and neck reconstruction to single surgeon reconstruction in a prospectively maintained database.

Results: 384 patients met our inclusion criteria from 2020 to 2022. Cases were performed by a single surgeon in 77.8 % of cases (299/384) and two surgeons in 22.1 % (85/384). The mean age was 62.5 years. There was no difference between the single surgeon cohort and the co-surgery cohort in terms of flap survival, procedure time, ischemia time, hospital length of stay, recipient site complications, or rates of return to the operating room. Donor site complications were less common in the co-surgery cohort (0 % vs 4.7 %, p = 0.021). For our reconstructive team, the transition to co-surgery has increased total surgeon fee collection per free flap by 28 % and increased surgeon flap related RVU production by 35 %.

Conclusion: Co-surgery is feasible and safe in head and neck microvascular reconstruction. Benefits may include reduced complications, increased reimbursement, and improved interdisciplinary collaboration.

Keywords: Co-surgery; Free flap; Head and neck cancer; Microvascular reconstruction.

MeSH terms

Free Tissue Flaps* / blood supply
Head / surgery
Head and Neck Neoplasms* / complications
Head and Neck Neoplasms* / surgery
Humans
Middle Aged
Neck / surgery
Plastic Surgery Procedures*
Postoperative Complications / etiology
Retrospective Studies