Achieving Textbook Outcomes in Bilateral DIEP Flap Breast Reconstruction: Does a Co-Surgeon Matter?

Area of Science:

• Plastic Surgery
• Surgical Quality Improvement
• Breast Reconstruction Outcomes

Background:

• Optimizing surgical outcomes is crucial for patient care.
• "Textbook outcomes" represent ideal results based on multiple quality metrics.
• Ensuring patient access to high-quality surgical centers is paramount.

Purpose of the Study:

• To evaluate predictors of "textbook outcomes" in bilateral Deep Inferior Epigastric Perforator (DIEP) flap breast reconstruction.
• To compare outcomes between single-surgeon and co-surgeon approaches in DIEP flap procedures.

Main Methods:

• Retrospective review of bilateral DIEP flap breast reconstructions (2017-2022).
• Defined "textbook outcome" criteria including OR time, length of stay, and complication rates.
• Utilized propensity score matching to compare single-surgeon and co-surgeon cohorts (47 matched pairs).

Main Results:

• Higher rate of textbook outcomes in the co-surgeon cohort (79%) versus the single-surgeon cohort (57%) (p=0.025).
• Significantly shorter average operating room (OR) time in the co-surgeon cohort (403 min) compared to the single-surgeon cohort (572 min) (p<0.0001).
• Elevated OR time was the primary reason for not achieving textbook outcomes; other criteria showed no significant differences.

Conclusions:

• A co-surgeon approach is associated with significantly higher rates of textbook outcomes in bilateral DIEP flap breast reconstruction.
• Shorter operating room times achieved with a co-surgeon appear to be the main driver of improved outcomes.
• Further investigation into factors influencing textbook outcomes in DIEP flap reconstruction is warranted.