J Reconstr Microsurg 2020; 36(08): 583-591
DOI: 10.1055/s-0040-1713173
Original Article

Assessing the Influence of Attending Surgeon Continuity on Free Flap Outcomes Following Unplanned Returns to the Operating Room

Ruya Zhao*
1  Duke University School of Medicine, Durham, North Carolina
,
Ronnie L. Shammas*
2  Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, North Carolina
,
Gloria Broadwater
3  Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
,
Elliot Le
1  Duke University School of Medicine, Durham, North Carolina
,
Christophe Hansen-Estruch
1  Duke University School of Medicine, Durham, North Carolina
,
Rayan Kaakati
1  Duke University School of Medicine, Durham, North Carolina
,
Roger W. Cason
2  Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, North Carolina
,
Matthew Lyes
1  Duke University School of Medicine, Durham, North Carolina
,
Jonah P. Orr
1  Duke University School of Medicine, Durham, North Carolina
,
Scott T. Hollenbeck
2  Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, North Carolina
› Author Affiliations
Funding None.

Abstract

Background Unplanned returns to the operating room (OR) may be necessary at times to salvage a compromised free flap. The aim of this study was to assess the influence of attending surgeon continuity on free flap outcomes following a return to the OR.

Methods We retrospectively reviewed patients who underwent free flap reconstruction and experienced an unplanned return to the OR within 30 days from 2002 to 2017. Logistic regression modeling was used to determine factors that predict unplanned returns to the OR.

Results Of the 1,177 patients were identified, 267 (22.5%) had an unplanned return to the OR. Of these, 69 (5.9%) patients experienced total flap loss. Overall, 216 take-back procedures were performed by the primary surgeons (80.2%), while 50 were performed by covering surgeons (18.8%). Flap loss occurred more frequently during a weekend procedure (p = 0.013). Additionally, when the take-back procedure was performed within 5 days of the original surgery by the primary as opposed to a covering surgeon, patients experienced lower estimated blood loss (75 vs. 150 cc, p = 0.04). Overall, there was a significantly lower incidence of flap loss when the take-back procedure was performed by the primary, as opposed to the covering, surgeon (20 vs. 47%, p = 0.0001).

Conclusion Higher rates of flap loss occur when a covering surgeon performs a take-back procedure in comparison to the primary surgeon. It is important to ensure the availability of the primary surgeon in the first few postoperative days following free flap reconstruction. When transfer of care is necessary, photographic or video documentation of the microvascular anastomosis may be helpful in addition to a verbal sign out.

* These authors contributed equally to this work.




Publication History

Received: 20 January 2020

Accepted: 05 May 2020

Publication Date:
18 June 2020 (online)

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