Co-surgery in Breast Reconstruction: Is the Helping Surgeon Actually Hurting?

Successful microsurgical autologous breast reconstruction (MABR) requires significant resources. The co-surgery model, involving 2 experienced surgeons, aims to improve outcomes. This study evaluated the financial and patient benefits of implementing a co-surgery model in MABR at an academic center.

A retrospective study was conducted on MABR procedures (2021-2023) at an academic cancer center. Encounters were categorized by the co-surgery modifier (-62) or single-surgeon. Financial data (expected versus actual payments, time to payment) and patient outcomes (complications, flap compromise) were collected. Statistical analysis used the Pearson χ² test and independent samples t test.

Of 393 encounters, 193 were single-surgeon, and 200 were co-surgery. Single-surgeon cases had more accurate payments (88.5% versus 76.4%, P < 0.001) and faster payment times (82.5 versus 103.9 d, P = 0.02). Co-surgery cases were underpaid by $86,748 during 3 years, with single-surgeon cases receiving $1200 more per patient. First-pass payment rates were higher for single surgeons (48.2% versus 39.5%, P = 0.04). Patient outcomes showed no significant differences in overall complications, donor-site complications, flap compromise, or flap loss, though the co-surgery group had higher infection rates (9.3% versus 0%, P < 0.01) and breast wounds (14% versus 1.3%, P < 0.01). Operative time and length of stay were comparable.

The co-surgery model in MABR enhances surgical efficiency but complicates billing, resulting in underpayment and delayed reimbursement. Streamlining reimbursement could foster co-surgery adoption, benefiting patient outcomes and efficiency.