The Financial Impact of a Cosurgeon in Breast Microsurgery.

[BACKGROUND] Cosurgeon approaches for autologous breast reconstruction have demonstrated improvements in operative efficiency. The health system financial impact, however, warrants further investigation.

[METHODS] Retrospective review of consecutive autologous reconstructions was performed between 2017 and 2022. Primary outcome measures consisted of length of stay, operative time, and financial metrics. Cases were stratified by cosurgeon presence, timing, and laterality.

[RESULTS] A total of 264 cases met inclusion criteria; these consisted of 117 cosurgeon and 147 single-surgeon cases. Cosurgeon cases demonstrated decreased length of stay (2.4 days versus 3.1 days; P < 0.01) and decreased operative time in unilateral (269 minutes versus 370 minutes; P < 0.01) and bilateral (399 minutes versus 582 minutes; P < 0.01) cases. Cosurgeon cases were also associated with decreased total cost ($25,160 versus $31,758; P < 0.01), direct cost ($15,558 versus $19,283; P < 0.01), and indirect cost ($9602 versus $12,475; P < 0.01); decreased total charges ($98,728 versus $120,981; P < 0.01); and increased margin ($1099 versus -$6255; P < 0.01). Post hoc analysis revealed significant differences, albeit at varying magnitudes, in these particular metrics across all levels of reconstruction timing with the inclusion of a cosurgeon.

[CONCLUSIONS] Cosurgeon breast microsurgery not only improves operative efficiency, but also translates to improved financial metrics. As the transition is made to value-based care models, this is particularly relevant to health systems offering microsurgical breast reconstruction. Analyses of downstream benefits including optimized patient throughput and surgeon opportunity cost warrant investigation.