The Financial Impact Of A Co-surgeon In Breast Microsurgery
Robert G. DeVito, M.D., Rachel H. Park, M.D., Chris A. Campbell, M.D., John T. Stranix, M.D..
University of Virginia, Charlottesville, VA, USA.
Purpose: Co-surgeon approaches for autologous breast reconstruction have demonstrated improvements in operative efficiency. The health system financial impact, however, warrants further investigation.
Methods: Retrospective review of consecutive autologous reconstructions between 2018-2021. Primary outcome measures: length of stay (LOS), operative time, and financial metrics. Cases were stratified by co-surgeon presence, timing, and laterality.
Results: 125 cases met inclusion criteria: 49 co-surgeon, 76 single surgeon. Co-surgeon cases demonstrated decreased LOS (2.7 vs. 3.6 days; p = 0.012), operative time in unilateral (317 vs. 423 minutes; p<0.01) and bilateral cases (470 minutes vs. 615 minutes; p<0.01), total charges ($106,197 vs. $132,457; p<0.01), total cost ($26,666 vs. $35,389; p<0.01), direct cost ($16,546 vs. $21,213; p<0.01), and increased estimated profit averaging $6,276 (p=0.023).
Conclusion: Co-surgeon breast microsurgery not only improves operative efficiency, but also translates to improved financial metrics. As we transition to value-based care models, this is particularly relevant to health systems offering microsurgical breast reconstruction. Analyses of downstream benefits including optimized patient throughput and surgeon opportunity cost warrant investigation. 
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