Co-surgeons in breast reconstructive microsurgery: What do they bring to the table?

Introduction: Current research within other surgical specialties suggests that a co-surgeon approach may reduce operative times and complications associated with complex bilateral procedures, possibly leading to improved patient and surgical outcomes. We sought to evaluate the role of the co-surgery team and its development in free flap breast reconstruction. Methods: A retrospective review of free-flap breast reconstruction by two surgeons from 2011 to 2016 was conducted. We analyzed 128 patients who underwent bilateral-DIEP breast. Surgical groups were: single-surgeon reconstruction (SSR; 35 patients), co-surgery where both surgeons are present for entire reconstruction (CSR-I; 69 patients), and co-surgery reconstruction where co-surgeons appropriately assist in two concurrent or staggered cases (CSR-II; 24 patients). Efficiency data collected was OR time and patient length-of-stay (LOS). The rate of flap-failure, return to OR, infection, wound breakdown, seroma, hematoma, and PE/DVT were compared. Results: Single-surgeon reconstruction had significantly longer OR time (678 vs. 485 min, P <.0001), LOS (5 vs. 3.9 days, P <.001), higher wound occurrences of the umbilical site that required surgical correction [11.4 percent (n = 4) vs. 1.5% (n = 1); P <.043] compared to CSR-I. Similarly, SSR had significantly longer average OR time (678 vs. 527 min P <.0001), average LOS (5 vs. 4 days, P =.0005) when compared with CSR-II. There were no total increased patient related complications associated with co-surgery (CSR-I or II). Conclusion: The addition of a co-surgeon, even with concurrent surgery, reduces operative time, average patient LOS, and postoperative complications. This work lends a strong credence that co-surgery model is associated with increased operative efficiency.