D28. Beating the Curve: Longitudinal Evaluation of Surgeon Proficiency in Microsurgical Breast Reconstruction Post-training

Abstract

PURPOSE: Microsurgical breast reconstruction is technically demanding, yet the learning curve is not well described. This study aimed to characterize the number of procedures required to master this technique proficiently and efficiently. METHODS: An institutional database was queried from 2006-2018 to identify all abdominally-based, breast free flaps performed by an experienced surgeon (ES) with almost 800 flaps experience and a novice surgeon (NS) entering practice immediately post fellowship. The primary outcome was operative time and secondary outcomes were major/minor complications. Risk-adjusted cumulative sum curves were used to determine expected number of procedures required to attain optimal efficiency, defined as the peak of rapid improvement in operative duration. Linear regression was used to stratify complication rates by procedure number, while controlling for confounders. RESULTS: A total of 1,288 procedures with a mean of 393 minutes (SD 123) were identified for both surgeons. NS’s operative time persistently decreased (-36.6 seconds/procedure, P<0.001) over the study period while ES was unchanged (P=0.353). There was no association between number of procedures and complications or partial/total flap loss (ES: P=0.423; NS: P=0.215). Greatest differential improvement in NS operative times was at approximately 300-350 procedures, 5 years post-training, while ES remained constant. CONCLUSION: Early microsurgical experience intimately correlates with reduced operative times, that peak after completing 300 free flaps, but persist well beyond 600. Gained efficiency does not compromise patient outcomes.