137. Comparison of Patient Outcomes and Efficiency of Microsurgeries Performed by Single Surgeon versus Co-surgeon

Abstract

INTRODUCTION: As we search for strategies to optimize operating room turnover rate, allocation of human and financial resources, and patient outcomes, surgeons may stand to benefit from co-operating with another surgeon for long and costly procedures. In Microsurgical Reconstruction literature, there has been increased attention to comparing outcomes of surgeries that used a two-surgeon approach compared to a one-surgeon approach in regards to operative times, complication rate, and so on. We today meta-analyze the outcome measures of microsurgeries performed by co-surgeons compared to single surgeons. PURPOSE: To demonstrate superior operative time, length of admission, complication rate, flap loss rate, and return to OR of microsurgeries performed by dual-surgeons versus single surgeons. METHODS: A medical librarian (LHY) searched the literature for records including concepts for dual surgeons and surgical benefits. We created search strategies using keywords and controlled vocabulary to search in databases including Embase, Ovid Medlin, Scopus, The Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov. Search strategies were completed April 29, 2020 resulting in 3,035 unique citations total. Three independent reviewers reviewed the literature and included 9 studies in microsurgery to identify the following data points: publication year, country, study design, type of surgical intervention performed, number of patients in the single-surgeon group, number of patients in the co-surgeon group, operative time (OT), length of stay (LOS), post-operative complications (POC), flap loss rate (FLR), and return to OR (LOR). If no standard deviation was provided, it was calculated based on published raw data. Literature that did not compare outcomes of single-surgeon to co-surgeon, or did not investigate microsurgical interventions, were excluded. A final revision for the correct data input was performed by a single reviewer, who ran statistical analysis. Meta-analysis and forest plots were created using RevMan Version 5. RESULTS: For each dependent variable, up to 7 papers qualified for inclusion. Results showed on average, Co-surgeon procedures were 50.0 minutes shorter than single surgeon procedures(95% CI: [-79.26, -20.67]). LOS was 0.46 days shorter for patients treated by co-surgeons (95% CI: [-0.81, -0.12],). For POC, the odds ratio for patients in co-surgeon group for having complications was 0.51 (95% CI [0.34, 0.75]). There was a tendency toward a lower FLR for patients in the co-surgeon groups (OR=0.48 [0.18, 1.30], p=0.15). Similarly, there was a trend toward fewer RTO in the co-surgeon group (OR=0.60 [0.35, 1.02], p=0.06). CONCLUSION: In the healthcare environment, where resources are at time scarce, multidisciplinary team approach might yield better outcomes. The dual-surgeon approach for microsurgical intervention decreases OT, LOS, POC, FLR, and RTO. This team structure decreases morbidity and improves healthcare resource utilization. The current literature demonstrates that patients, surgical teams, and the healthcare system at large stand to benefit when there are two-surgeons at the operative table. Institutional support for this team structure should be prioritized in centers where microsurgery is performed.