University of California, San Francisco San Francisco, California
Background: Microvascular free tissue transfer (MFTT) success rates have increased, but it remains a challenging endeavor. We evaluated outcomes between single and multiple MFTT cases completed by a single surgeon in one day.
Learning Objectives: Identify a potential risk factor in MFTT failure
Study objective: Evaluate association between number of MFTT cases performed per day and complication rates
Design type: Retrospective cohort
Method: Operative details and outcomes were compared for MFTT cases performed at a tertiary care center from August 2011-September 2021.
Results: 1055 cases were performed by 8 surgeons. There were 51 instances of a surgeon performing multiple MFTT cases per day, representing 103 free flaps (9.8%). Eleven instances (22 flaps) involved two flaps in the same patient (SP), while 40 (81 cases) involved unique patients (UP).
Overall, there were 105 (10.1%) unplanned operating room returns (“takeback”) and 22 (2.1%) flap failures. Takeback rates were similar when surgeons performed 1 vs. >1 MFTT (10.1% vs. 9.1%, p=0.9), but cases with 2 SP flaps had a higher rate (31.8%) than 2 UP flaps (3.7%, p=0.001). Flap failure was greater on days with >1 case (1.8% vs. 4.9%, p=0.04) and higher with 2 SP flaps (13.6%) than 2 UP flaps (2.5%) or single cases (1.8%, p=0.01). Failure (p=0.65) and takeback (p=0.07) rates were not different between days with 1 case and 2 UP flaps.
Conclusions: Complication rates were similar when a surgeon performed single or multiple unique-patient MFTT cases per day. This information can inform surgical planning as MFTT demand increases.