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.
Keywords
free flap - microsurgery - reconstruction - return to operating room
