頭頸部悪性腫瘍に対する遊離組織移植再建における形成外科医と耳鼻咽喉科医の症例数と転帰の比較

This study captures free tissue transfer reconstructions following head and neck neoplasm resection and assesses case volumes and clinical endpoints by surgeon specialty.

The American College of Surgeons National Surgical Quality Improvement Program database was queried from 2012 to 2020 using Current Procedural Terminology and International Classification of Diseases codes specific for free tissue transfers in the setting of head and neck neoplasms. Primary 30-day outcomes of interest included wound complications, medical complications, postoperative length of stay, nonhome discharge, and return to operating room.Case volumes between plastic surgeons and otolaryngologists were compared. Bivariate statistics were performed to compare patient characteristics and outcomes between plastic surgeons and otolaryngologists during the study period. Multivariate logistic regression models using clinical covariates were constructed to assess whether surgeon specialty was an independent predictor of outcomes. Significance was set at P < 0.05 and a Bonferroni correction was applied to adjust for multiple hypothesis testing (n = 49).

Overall, 3903 free tissue transfers were included (plastic surgeons: 1603, otolaryngologists: 2300). Reconstructions performed by plastic surgeons had increased operative time (583 minutes vs 528, P < 0.001) and were more likely osseous tissue transfers (P < 0.001). Multivariate analysis revealed increased postoperative length of stay in reconstructions performed by plastic surgeons (P = 0.002). Osseous tissue transfers had significantly increased operative time and length of stay when compared to soft-tissue transfers (P < 0.001).

Outcomes between plastic surgeons and otolaryngologists are similar in the setting of head and neck free tissue transfer reconstructions before and after adjusting for patient-specific factors. Given this lack of difference, our study supports the notion that surgical specialty can effectively perform these reconstructions and efforts should be made to maintain case volumes for plastic surgeons.