The Co-Surgeon Model for Microsurgical Free Flaps: A Survey of Perspectives and Utility

Abstract

Background

Reconstructive microsurgery remains a demanding field, requiring technical expertise and long operating hours. This places microsurgeons at increased risk of dissatisfaction and burnout. The co-surgeon model has been developed to mitigate these challenges. This study was designed to evaluate microsurgeon perspectives on the characteristics and impact of the co-surgeon model for microsurgical free flaps.

Methods

An electronic anonymous survey was distributed via email to attending microsurgeon members of the American Society of Reconstructive Microsurgeons. The survey collected various demographic and practice-related information including Likert scale questions to assess microsurgeon perspectives on the utility of the co-surgeon model.

Results

A total of 862 microsurgeons received the survey, with 102 responses available for analysis. The average age of respondents was 46.6 (± 9.7) years. Most of the microsurgeons were male (71%) practicing in the United States (93%), with 74.5% of respondents utilizing a co-surgeon model in their practice. Bilateral breast flaps were the most common microsurgical procedure performed using a co-surgeon (85%), followed by head and neck free flaps (60%), with immediate lymphatic reconstruction being the least common (3.1%). On the day of the co-surgery case, the co-surgeon was more likely than the primary surgeon to have additional cases (68.4 and 36.4%, respectively), with the additional cases being rarely free flaps. More than 80% of microsurgeons stated that the co-surgeon model improves “very much” or “quite a bit” operative efficiency and duration, as well as surgeon well-being and career longevity.

Conclusion

This study provides new insight into the utility of using a co-surgeon for free flap reconstruction by demonstrating that approximately 80% of microsurgeons have a positive perception of the model's impact on procedure efficiency, operative time, surgeon well-being, and career longevity. Therefore, adopting a co-surgeon model for microsurgical free flap reconstruction may be useful in reducing burnout and promoting well-being among microsurgeons.

Keywords

co-surgeon - perioperative case - free flap reconstruction - reconstructive microsurgery

Ethical Approval

The ethical approval was granted by the Institutional Review Board at RUSH (23070701).

Publikationsverlauf

Eingereicht: 13. Oktober 2024

Angenommen: 26. Januar 2025

Accepted Manuscript online:
24. Februar 2025

Artikel online veröffentlicht:
24. März 2025

• References

• 1 Kuerer HM, Eberlein TJ, Pollock RE. et al. Career satisfaction, practice patterns and burnout among surgical oncologists: report on the quality of life of members of the Society of Surgical Oncology. Ann Surg Oncol 2007; 14 (11) 3043-3053
• 2 Balch CM, Freischlag JA, Shanafelt TD. Stress and burnout among surgeons: understanding and managing the syndrome and avoiding the adverse consequences. Arch Surg 2009; 144 (04) 371-376
• 3 Nguyen PD, Herrera FA, Roostaeian J, Da Lio AL, Crisera CA, Festekjian JH. Career satisfaction and burnout in the reconstructive microsurgeon in the United States. Microsurgery 2015; 35 (01) 1-5
• 4 Offodile II AC, Aherrera A, Wenger J, Rajab TK, Guo L. Impact of increasing operative time on the incidence of early failure and complications following free tissue transfer? A risk factor analysis of 2,008 patients from the ACS-NSQIP database. Microsurgery 2017; 37 (01) 12-20
• 5 Shtarbanov P, Ioannidi L, Hamilton S. et al. Prolonged operative time is a risk factor for adverse postoperative outcomes in the unilateral deep inferior epigastric perforator (DIEP) flap surgery: A retrospective cohort study. J Plast Reconstr Aesthet Surg 2023; 87: 180-186
• 6 Sweeny L, Rosenthal EL, Light T. et al. Outcomes and cost implications of microvascular reconstructions of the head and neck. Head Neck 2019; 41 (04) 930-939
• 7 Shaikh N, Noor K, Jafary H, Chung J, Fancy T, Stokes W. Effect of 2 teams and operative time on complications after oral cavity free flap reconstruction. Ann Otol Rhinol Laryngol 2023; 132 (11) 1430-1437
• 8 Daher M, Kreichati G, Kharrat K. et al. Dual versus single attending surgeon performance of spinal deformity surgery? a meta-analysis. World Neurosurg 2024; 188: 93-98
• 9 Bertolo R, Carilli M, Antonucci M, Maiorino F, Bove P, Vittori M. “Single-surgeon” versus “dual-surgeon” robot-assisted radical prostatectomy and pelvic lymph-nodes dissection: comparative analysis of perioperative outcomes. Int Braz J Urol 2023; 49 (06) 732-739
• 10 Menapace B, McCarthy J, Schultz L, Leitsinger N, Jain V, Sturm P. Utilizing two surgeons for neuromuscular scoliosis suggests improved operative efficiency. Spine Deform 2023; 11 (04) 985-992
• 11 Escandón JM, Mascaro-Pankova A, DellaCroce FJ. et al. The value of a co-surgeon in microvascular breast reconstruction: a systematic review and meta-analysis. Plast Reconstr Surg Glob Open 2024; 12 (02) e5624
• 12 Attalla P, Becker M, Clark RC, Reid CM, Brazio PS. We are not speaking the same language: current procedural terminology coding and provision of care in lymphatic reconstruction. Ann Plast Surg 2024; 92 (5S, Suppl 3) S310-S314
• 13 Yang AZ, Hyland CJ, Thomas C, Miller AS, Malek AJ, Broyles JM. Geographic disparities and payment variation for immediate lymphatic reconstruction in Massachusetts. Ann Plast Surg 2024; 93 (01) 79-84
• 14 Jesuyajolu D, Nicholas A, Okeke C. et al. Burnout among surgeons and surgical trainees: A systematic review and meta-analysis of the prevalence and associated factors. Surg Pract Sci 2022; 10: 100094
• 15 Maslach C, Leiter MP. Understanding the burnout experience: recent research and its implications for psychiatry. World Psychiatry 2016; 15 (02) 103-111
• 16 Al-Ghunaim T, Johnson J, Biyani CS, Yiasemidou M, O'Connor DB. Burnout and patient safety perceptions among surgeons in the United Kingdom during the early phases of the coronavirus disease 2019 pandemic: a two-wave survey. Scott Med J 2023; 68 (02) 41-48
• 17 Balendran B, Bath MF, Awopetu AI, Kreckler SM. Burnout within UK surgical specialties: a systematic review. Ann R Coll Surg Engl 2021; 103 (07) 464-470
• 18 Streu R, Hansen J, Abrahamse P, Alderman AK. Professional burnout among US plastic surgeons: results of a national survey. Ann Plast Surg 2014; 72 (03) 346-350
• 19 Haddock NT, Kayfan S, Pezeshk RA, Teotia SS. Co-surgeons in breast reconstructive microsurgery: what do they bring to the table?. Microsurgery 2018; 38 (01) 14-20
• 20 Xu J, Zhu XM, Ng KC, Alhefzi MM, Avram R, Coroneos CJ. Co-surgeon versus single-surgeon outcomes in free tissue breast reconstruction: a meta-analysis. J Reconstr Microsurg 2024; 40 (08) 589-600
• 21 Kwok AC, Goodwin IA, Ying J, Agarwal JP. National trends and complication rates after bilateral mastectomy and immediate breast reconstruction from 2005 to 2012. Am J Surg 2015; 210 (03) 512-516
• 22 Kulkarni AR, Sears ED, Atisha DM, Alderman AK. Use of autologous and microsurgical breast reconstruction by U.S. plastic surgeons. Plast Reconstr Surg 2013; 132 (03) 534-541
• 23 Razdan SN, Panchal HJ, Hespe GE. et al. The impact of the cosurgeon model on bilateral autologous breast reconstruction. J Reconstr Microsurg 2017; 33 (09) 624-629
• 24 Bauermeister AJ, Zuriarrain A, Newman M, Earle SA, Medina III MA. Impact of continuous two-team approach in autologous breast reconstruction. J Reconstr Microsurg 2017; 33 (04) 298-304
• 25 Mauch JT, Byrnes YM, Kotian AA, Catzen HZ, Byrnes ME, Myers PL. Microsurgeon development, attrition, and hope for the future: a qualitative analysis. J Reconstr Microsurg 2024;
• 26 Wen YE, Steppe C, Teotia SS, Haddock NT. Operative time predicts long-term abdominal morbidity and complication requiring treatment after DIEP flap breast reconstruction. J Reconstr Microsurg 2024; 40 (03) 217-226
• 27 Ehrl D, Heidekrueger PI, Ninkovic M, Broer PN. Impact of two attendings on the outcomes of microvascular limb reconstruction. J Reconstr Microsurg 2018; 34 (01) 59-64
• 28 Haddock NT, Teotia SS. Efficient DIEP flap: bilateral breast reconstruction in less than four hours. Plast Reconstr Surg Glob Open 2021; 9 (09) e3801