Evaluation of Co-Surgeon versus Single-Surgeon Bilateral Mastectomy Operations
*Melissa A Mallory1,2, *Constantine Tarabanis1,2, *Eric Schneider3, *Suniti Nimbkar1,2, Mehra Golshan1,2
1Dana Farber/Brigham and Women's Hospital, Boston, MA;2Harvard Medical School, Boston, MA;3Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA
Objective: Bilateral mastectomy (BM) is traditionally performed by a single surgeon (SS); a co-surgeon (CS) technique, where each surgeon concurrently performs a unilateral mastectomy, offers an alternative approach. We sought to compare the CS and SS BM-technique with respect to operative times and complications.
Design:Retrospective Analysis
Setting:Academic Medical Center 2005-2015
Patients:Patients undergoing BM without reconstruction performed by CS and SS
Interventions:Patients were identified using operative case logs, and stratified into CS- and SS-cohorts. Operative time (OT; incision to closure) was calculated. Patient age, presence/stage of cancer, hormone receptor/BRCA status, breast weight, axillary-procedure performed, and 30-day postoperative complications were extracted from medical records.
Main Outcome Measures: 1) Differences in OT, complication rates, and demographic characteristics between CS- and SS-cohorts 2) Factors associated with OT Results:109 BM cases were performed without immediate reconstruction [CS, n = 58 (53.2%); SS, n = 51 (46.8%)]. Average BM duration was significantly shorter for CS cases by 33 minutes (21.6% reduction; CS: 120 min versus SS: 153 min, p<0.001), with no difference in short-term complication rates (p = 0.65). Demographic characteristics didn’t differ between cohorts except for total breast weight(TBW) (CS: 1878g versus SS: 1452g, p<0.05). Adjusting for TBW in the regression model, the CS-technique offered a 27.8% reduction (44-minutes savings, p<0.001) in OT compared to the SS-technique.
Conclusions:OT for BMs is significantly reduced when performed by CS compared to SS, however the observed time reduction was less than would be anticipated (50%) with a CS-approach. The CS-approach to BM appears to be of most benefit in large total breast weight cases.
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