Co-Surgeons in Breast Reconstructive Microsurgery: What Do They Bring to the Table?

INTRODUCTION: Current research within other surgical specialties suggests that a co-surgeon approach may reduce operative times and complications associated with complex bilateral procedures, possibly leading to improved patient and surgical outcomes. We sought to evaluate the role of the co-surgery team and its development in free flap breast reconstruction. METHODS: A retrospective review of free-flap breast reconstruction by two surgeons from 2011-2016 was conducted. We analyzed 128 patients who underwent bilateral-DIEP breast. Surgical groups were: single-surgeon reconstruction (SSR; 35 patients), Co-Surgery where both surgeons are present for entire reconstruction (CSR-I; 69 patients), and Co-Surgery reconstruction where co-surgeons appropriately assist in two concurrent or staggered cases (CSR-II; 24 patients). Efficiency data collected was OR time and patient length-of-stay (LOS). The rate of flap-failure, return to OR, infection, wound breakdown, seroma, hematoma and PE/DVT were compared. RESULTS: Single-surgeon reconstruction had significantly longer OR time (678 vs 485 minutes, p< 0.0001), LOS (5 vs 3.9 days, p<0.001), higher wound occurrences of the umbilical site that required surgical correction [11.4 percent (n=4) versus 1.5 percent,(n=1); p<0.043] compared to CSR-I. Similarly, SSR had significantly longer average OR time (678 vs 527 minutes p< 0.0001), average LOS (5 days vs 4 days, p=0.0005) when compared to CSR-II. There were no total increased patient related complications associated with co-surgery (CSR- I or II). CONCLUSION: The addition of a Co-surgeon, even with concurrent surgery, reduces operative time, average patient LOS, and post-operative complications. This work lends a strong credence that Co-surgery model is associated with increased operative efficiency.