D142. Concurrent Co-surgeon DIEP Flap Breast Reconstructions: Feasibility and Clinical Outcomes

Abstract

PURPOSE: A co-surgeon model has been shown to be a favorable approach for microvascular breast reconstruction, but concurrent co-surgeon DIEP flap cases have not been well-studied. The authors hypothesize that performing two concurrent co-surgeon bilateral DIEP flap reconstructions would increase productivity and result in non-inferior clinical outcomes. METHODS: A single-institution, retrospective cohort study was designed utilizing electronic medical record review to identify all cases of co-surgeon free flap breast reconstructions over a 38-month period. Subsequently, study patients who specifically underwent concurrent bilateral DIEP flap breast reconstructions with the same two co-surgeons were identified. The control group consisted of subjects who underwent non-concurrent reconstruction within the same, preceding, or following month of those in the study group. Primary outcome variables were minor and major complications within 90-days postoperatively. Secondary outcome variables were operating time and length of hospital stay. Descriptive statistics, univariate analysis, and multivariate regression analysis were performed. RESULTS: 137 subjects were identified, and 64 met inclusion criteria (n=28 study group, n=36 control). There was no statistically significant difference between the groups in age, BMI, radiation, trainee experience, or immediate/delayed reconstruction. There was no statistically significant difference in minor and major complications including anastomosis revision, takeback to operating room, or readmission. Operative time was longer in the study group (540.5 vs. 451.7 minutes, p<0.0001). There was no statistically significant difference in length of hospital stay. CONCLUSION: Concurrent co-surgeon approach to bilateral DIEP flap breast reconstruction increases productivity and does not result in a higher complication rate, compared to non-concurrent operations.