Co-surgery in head and neck microvascular reconstruction

• Published in: American journal of otolaryngology Vol. 45; no. 1; p. 104062
• Main Authors: Dang, Sophia, Green, Katerina, Bottegal, Matthew, Khan, Nayel I., Solari, Mario G., Sridharan, Shaum S., Kubik, Mark W.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-01-2024
• Subjects: Co-surgery; Free flap; Head and neck cancer; Microvascular reconstruction; Co-surgery; Head and neck cancer; Microvascular reconstruction; Free flap
• ISSN: 0196-0709; 1532-818X
• DOI: 10.1016/j.amjoto.2023.104062

Co-surgery with two attending reconstructive surgeons is becoming increasingly common in breast microvascular reconstruction due to case complexity and the potential for improved outcomes and operative efficiency. The impact of co-surgery on outcomes in head and neck microvascular reconstruction has not been studied.
Our multidisciplinary head and neck reconstruction team (Otolaryngology, Plastic Surgery) at the University of Pittsburgh transitioned to a practice of co-surgery on head and neck free flaps. In this study, we compare outcomes of two surgeon head and neck reconstruction to single surgeon reconstruction in a prospectively maintained database.
384 patients met our inclusion criteria from 2020 to 2022. Cases were performed by a single surgeon in 77.8 % of cases (299/384) and two surgeons in 22.1 % (85/384). The mean age was 62.5 years. There was no difference between the single surgeon cohort and the co-surgery cohort in terms of flap survival, procedure time, ischemia time, hospital length of stay, recipient site complications, or rates of return to the operating room. Donor site complications were less common in the co-surgery cohort (0 % vs 4.7 %, p = 0.021). For our reconstructive team, the transition to co-surgery has increased total surgeon fee collection per free flap by 28 % and increased surgeon flap related RVU production by 35 %.
Co-surgery is feasible and safe in head and neck microvascular reconstruction. Benefits may include reduced complications, increased reimbursement, and improved interdisciplinary collaboration.