Single surgeon versus co‐surgeon bilateral mastectomy: Comparing outcomes and costs based on health economic modeling from the perspective of the hospital system

Abstract

Introduction: Co-surgeon approach for bilateral mastectomy may lead to shorter operative times and improved outcomes compared with single-surgeon approach, but cost differences remain unclear. Economic models were applied to determine whether either approach offered a lower cost opportunity. Methods: A retrospective review of 409 patients undergoing single-surgeon or cosurgeon bilateral mastectomy between January 1, 2010 through April 30, 2016 was conducted. Outcomes included narcotic and antinausea doses, length of stay (LOS), and operative time. Analyses stratified by reconstruction and no reconstruction included Wilcoxon tests, Poisson regression, generalized linear models, and a cost calculator. Results: Of 409 patients, 310 had reconstruction and 99 had no reconstruction.Compared with single-surgeon approach, co-surgeon approach was associated with less operative time and shorter LOS (233 vs. 250 min and 1.0 vs. 1.8 days no reconstruction; and 429 vs. 493 min and 2.2 vs. 2.8 days reconstruction). Economic analysis demonstrated less operative time, shorter LOS, and lower average cost for co-surgeon approach

The Value of a Co-surgeon in Microvascular Breast Reconstruction: A Systematic Review and Meta-analysis

“…1 Another strategy to optimize perioperative outcomes can be the incorporation of a co-surgeon. 10–15 With this modality, critical steps of complex microsurgical reconstructive procedures can occur concurrently rather than in sequence. 1…”

“…[10][11][12][13][14][15] With this modality, critical steps of complex microsurgical reconstructive procedures can occur concurrently rather than in sequence. 1 Reduced operative time, shorter length of stay, and lesser healthcare-associated costs have been reported with a co-surgeon model for the ablative segment of breast oncologic procedures (mastectomy), [10][11][12] whereas reduced estimated blood loss, 14,15 complication rates, 14 requirements of narcotics, 15 operative time, and improved operating room utilization costs have been reported in the field of orthopedic and neurological surgery with a co-surgeon. [13][14][15] The purpose of this review was to evaluate the role of a co-surgeon model for microvascular breast reconstruction (MBR) in plastic surgery.…”