Co-surgeon versus single-surgeon outcomes in free tissue breast reconstruction: a meta-analysis.

BACKGROUND: Autologous breast reconstruction offers superior long-term patient reported outcomes compared to implant-based reconstruction. Universal adoption of free tissue transfer has been hindered by procedural complexity and long operative time with microsurgery. In many specialties, co-surgeon approaches are reported to decrease operative time while improving surgical outcomes. This systematic review and meta-analysis synthesizes the available literature to evaluate the potential benefit of a co-surgeon approach in autologous free tissue breast reconstruction versus single-surgeon.

METHODS: A systematic review and meta-analysis was conducted using Pubmed,Embase and MEDLINE from inception to December 2022. Published reports comparing co-surgeon (CS) to single-surgeon (SS) approaches in uni- and bilateral autologous breast reconstruction were identified. Primary outcomes included operative time, post-operative outcomes, processes of care, and financial impact. Risk of bias was assessed and outcomes were characterized with effect sizes.

RESULTS: Eight retrospective studies reporting on 9425 patients were included. Compared with SS, CS approach was associated with a significantly shorter operative time (SMD,-0.65,95% CI -1.01 to -0.29,p<0.001), with the largest effect size in bilateral reconstructions(SMD,-1.02,95% CI -1.37 to -0.67,p<0.00001). CS was also associated with a significant decrease in length of hospitalization(SMD,-0.39,95% CI -0.71 to -0.07,p=0.02). Odds of flap failure or surgical complications including surgical site infection, hematoma, fat necrosis and re-exploration were not significantly different.

CONCLUSION: CS free tissue breast reconstruction significantly shortens operative time and length of hospitalization compared to SS approaches without compromising post-operative outcomes. Further research should model processes and financial viability of its adoption in a variety of healthcare models.