Outcomes of Microvascular Free Flap Reconstruction With One Versus Two Primary Surgeons.

[OBJECTIVE] To evaluate operative efficiency and quality in head and neck free flap reconstruction with one versus two primary surgeons by comparing procedure duration, hospital length of stay, complications and readmission rates.

[STUDY DESIGN] Retrospective chart review.

[SETTING] Single-institution tertiary care centre.

[METHODS] A total of 583 patients who received head and neck surgery with free flap reconstruction at the University of Kansas Medical Center between November 2010 and January 2021 were stratified into two cohorts: one-surgeon cohort and two-surgeon cohort. In the two-surgeon cohort, one surgeon performed tissue resection and the second performed reconstruction (n = 329), whereas one primary surgeon performed both resection and reconstruction in the one-surgeon cohort (n = 254). Patient age, sex, American Society of Anaesthesia (ASA) status and Charlson comorbidity index (CCI) at time of surgery were collected.

[RESULTS] No significant difference in baseline clinicodemographic characteristics was found between groups. A reduced mean procedure duration was found in the one-surgeon cohort (424.9 min, SD 127.6) compared to the two-surgeon cohort (552.4 min, SD 119.2) (mean difference 127.5 min, Cohen d = 1.04). A slightly greater proportion of osteocutaneous free flaps was performed in the two-surgeon cohort compared to the one-surgeon cohort (one-surgeon: 53.5%; two-surgeon 62.3%). All other secondary quality measures showed nonsignificant differences with the exception of the proportion requiring intraoperative pressors (86.2% in one-surgeon cohort vs. 74.5% in two-surgeon cohort, mean difference 11.7%, Cohen d = 0.29).

[CONCLUSIONS] This study demonstrates at least noninferior efficiency and quality outcomes in free flap cases led by single primary surgeons at our institution. The optimal approach to maximise operative efficiency and quality likely differs across surgeons and centres.

[LEVEL OF EVIDENCE] III.