by Mericli, Alexander F.; Chu, Carrie K.; Sisk, Geoffroy C.;
Largo, Rene D.; Schaverien, Mark V.; Liu, Jun; Villa, Mark T.; Garvey, Patrick
B.
Plastic and Reconstructive Surgery: February 2022
- Volume 149 - Issue 2 - p 338-348
Background: Reducing complications while controlling costs
is a central tenet of value-based health care. Bilateral microvascular breast
reconstruction is a long operation with a relatively high complication rate.
Using a two-surgeon team has been shown to improve safety in bilateral
microvascular breast reconstruction; however, its impact on cost and efficiency
has not been robustly studied. The authors hypothesized that a cosurgeon for
bilateral microvascular breast reconstruction is safe, effective, and
associated with reduced costs.
Methods: The authors retrospectively reviewed all patients
who underwent bilateral microvascular breast reconstruction with either a
single surgeon or surgeon/cosurgeon team over an 18-month period. Charges were
converted to costs using the authors’ institutional cost-to-charge ratio.
Surgeon opportunity costs were estimated using time-driven activity-based
costing. Propensity scoring controlled for baseline characteristics between the
two groups. A locally weighted logistic regression model analyzed the
cosurgeon’s impact on outcomes and costs.
Results: The authors included 150 bilateral microvascular
breast reconstructions (60 single-surgeon and 90 surgeon/cosurgeon
reconstructions) with a median follow-up of 15 months. After matching, the
presence of a cosurgeon was associated with a significantly reduced mean
operative duration (change in operative duration, −107 minutes; p < 0.001)
and cost (change in total cost, −$1101.50; p < 0.001), which was even more
pronounced when surgeon/cosurgeon teams worked together frequently (change in
operative duration, −132 minutes; change in total cost, −$1389; p = 0.007). The
weighted logistic regression models identified that a cosurgeon was protective
against breast-site complications and trended toward reduced overall and major
complication rates.
Conclusion: The practice of using a of cosurgeon appears to
be associated with reduced costs and improved outcomes, thereby potentially
adding value to bilateral microvascular breast reconstruction. CLINICAL
QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
