The Impact Of Co-surgeon Use On Operating Room Efficiency Of Deep Inferior Epigastric Perforator (diep) Flap Breast Reconstruction Over Time

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PURPOSE: The impact of a co-surgeon during DIEP flap breast reconstruction has been cited in the literature to improve operative times compared to a single primary surgeon. However, these effects have not been studied over time. METHODS: A retrospective, IRB-approved review of all bilateral DIEP flap breast reconstruction procedures was performed at our institution from 2022 to 2024 from a primary surgeon. Primary variables were number of co-surgeons, additional performed procedures, and operative times. RESULTS: 122 patients underwent DIEP flap breast reconstruction with the senior author with 208 DIEP flaps performed. Breast flap reconstruction patients had an average age of 49.84 years and an average BMI of 29.84. The majority of patients underwent additional procedures including tissue expander removal in 93 breasts, capsulotomy in 72 breasts, and implant removal in 25 breasts. There was a statistically significant decrease in operative time from 2022 (8.91 hrs) to 2024 (7.63 hrs) (p0.05). Co-surgeons performed an average of 22.67 cases with the primary surgeon (range: 13-42). Linear regression analysis of primary surgeon and co-surgeon familiarity demonstrated the most drastic decrease in operative time in the first 20 cases together (P 0.001). After the first 20 cases, the operative time for bilateral DIEP cases decreased at a statistically insignificant rate. CONCLUSION: Our study demonstrates a significant reduction in bilateral DIEP flap breast reconstruction operative time with the use of a co-surgeon, over the first twenty cases performed together and highlight the importance of establishing a consistent operative team.

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