{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T04:38:11Z","timestamp":1780720691411,"version":"3.54.1"},"reference-count":43,"publisher":"Georg Thieme Verlag KG","issue":"08","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003Autologous breast reconstruction offers superior long-term patient reported outcomes compared with implant-based reconstruction. Universal adoption of free tissue transfer has been hindered by procedural complexity and long operative time with microsurgery. In many specialties, co-surgeon (CS) approaches are reported to decrease operative time while improving surgical outcomes. This systematic review and meta-analysis synthesizes the available literature to evaluate the potential benefit of a CS approach in autologous free tissue breast reconstruction versus single-surgeon (SS).<\/jats:p><jats:p>\n          Methods\u2003A systematic review and meta-analysis was conducted using PubMed, Embase, and MEDLINE from inception to December 2022. Published reports comparing CS to SS approaches in uni- and bilateral autologous breast reconstruction were identified. Primary outcomes included operative time, postoperative outcomes, processes of care, and financial impact. Risk of bias was assessed and outcomes were characterized with effect sizes.<\/jats:p><jats:p>\n          Results\u2003Eight retrospective studies reporting on 9,425 patients were included. Compared with SS, CS approach was associated with a significantly shorter operative time (SMD \u22120.65, 95% confidence interval [CI] \u22121.01 to \u22120.29, p\u2009&lt;\u20090.001), with the largest effect size in bilateral reconstructions (standardized mean difference [SMD] \u22121.02, 95% CI \u22121.37 to \u22120.67, p\u2009&lt;\u20090.00001). CS was also associated with a significant decrease in length of hospitalization (SMD \u22120.39, 95% CI \u22120.71 to \u22120.07, p\u2009=\u20090.02). Odds of flap failure or surgical complications including surgical site infection, hematoma, fat necrosis, and reexploration were not significantly different.<\/jats:p><jats:p>\n          Conclusion\u2003CS free tissue breast reconstruction significantly shortens operative time and length of hospitalization compared with SS approaches without compromising postoperative outcomes. Further research should model processes and financial viability of its adoption in a variety of health care models.<\/jats:p>","DOI":"10.1055\/a-2253-6099","type":"journal-article","created":{"date-parts":[[2024,1,25]],"date-time":"2024-01-25T00:22:45Z","timestamp":1706142165000},"page":"589-600","source":"Crossref","is-referenced-by-count":7,"title":["Co-surgeon versus Single-surgeon Outcomes in Free Tissue Breast Reconstruction: A Meta-analysis"],"prefix":"10.1055","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8318-5669","authenticated-orcid":false,"given":"Joshua","family":"Xu","sequence":"additional","affiliation":[{"name":"Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xi Ming","family":"Zhu","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly C.","family":"Ng","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muayyad M.","family":"Alhefzi","sequence":"additional","affiliation":[{"name":"Department of Surgery, King Khalid University, Abha, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronen","family":"Avram","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher J.","family":"Coroneos","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada"},{"name":"Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2024,2,21]]},"reference":[{"issue":"04","key":"ref1","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1097\/PRS.0000000000002536","article-title":"A comparison of psychological response, body image, sexuality, and quality of life between immediate and delayed autologous tissue breast reconstruction: a prospective long-term outcome study","volume":"138","author":"T Zhong","year":"2016","journal-title":"Plast Reconstr Surg"},{"issue":"10","key":"ref2","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1001\/jamasurg.2018.1677","article-title":"Long-term patient-reported outcomes in postmastectomy breast reconstruction","volume":"153","author":"K B Santosa","year":"2018","journal-title":"JAMA Surg"},{"issue":"01","key":"ref3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/PRS.0b013e3181ab10b2","article-title":"Patient-reported aesthetic satisfaction with breast reconstruction during the long-term survivorship period","volume":"124","author":"E S Hu","year":"2009","journal-title":"Plast Reconstr Surg"},{"issue":"03","key":"ref4","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1097\/SLA.0000000000003467","article-title":"Long-term patient-reported outcomes following postmastectomy breast reconstruction: an 8-year examination of 3268 patients","volume":"270","author":"J A Nelson","year":"2019","journal-title":"Ann Surg"},{"issue":"06","key":"ref5","doi-asserted-by":"crossref","first-page":"1585","DOI":"10.1097\/PRS.0b013e3181cb6351","article-title":"Patient satisfaction in postmastectomy breast reconstruction: a comparative evaluation of DIEP, TRAM, latissimus flap, and implant techniques","volume":"125","author":"J H Yueh","year":"2010","journal-title":"Plast Reconstr Surg"},{"issue":"02","key":"ref6","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1016\/j.bjps.2019.09.040","article-title":"Autologous versus implant-based breast reconstruction: a systematic review and meta-analysis of Breast-Q patient-reported outcomes","volume":"73","author":"N M Toyserkani","year":"2020","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"01","key":"ref7","doi-asserted-by":"crossref","first-page":"e1217","DOI":"10.1097\/GOX.0000000000001217","article-title":"Comparison of patient-reported outcomes after implant versus autologous tissue breast reconstruction using the BREAST-Q","volume":"5","author":"O Pirro","year":"2017","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"04","key":"ref8","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1111\/tbj.14186","article-title":"A comprehensive literature review of patient-reported outcome measures (PROMs) among common breast reconstruction options: what types of breast reconstruction score well?","volume":"27","author":"S Char","year":"2021","journal-title":"Breast J"},{"issue":"02","key":"ref9","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1097\/PRS.0000000000006422","article-title":"Autologous breast reconstruction versus implant-based reconstruction: how do long-term costs and health care use compare?","volume":"145","author":"V Lemaine","year":"2020","journal-title":"Plast Reconstr Surg"},{"issue":"01","key":"ref10","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1097\/PRS.0b013e3182729cde","article-title":"A paradigm shift in U.S. breast reconstruction: increasing implant rates","volume":"131","author":"C R Albornoz","year":"2013","journal-title":"Plast Reconstr Surg"},{"issue":"03","key":"ref11","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1097\/PRS.0b013e31829ae03e","article-title":"Use of autologous and microsurgical breast reconstruction by U.S. plastic surgeons","volume":"132","author":"A R Kulkarni","year":"2013","journal-title":"Plast Reconstr Surg"},{"issue":"11","key":"ref12","doi-asserted-by":"crossref","first-page":"1620","DOI":"10.1002\/bjs.1800811119","article-title":"Two-team synchronous oesophagectomy","volume":"81","author":"G C Gurtner","year":"1994","journal-title":"Br J Surg"},{"issue":"04","key":"ref13","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1089\/lap.2009.0364","article-title":"Retroperitoneal laparoscopic nephrectomy: the effect of the learning curve, and concentrating expertise, on operating times","volume":"20","author":"A Skinner","year":"2010","journal-title":"J Laparoendosc Adv Surg Tech"},{"issue":"01","key":"ref14","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.surg.2009.06.027","article-title":"Two-surgeon technique of parenchymal transection contributes to reduced transfusion rate in patients undergoing major hepatectomy: analysis of 1,557 consecutive liver resections","volume":"147","author":"M Palavecino","year":"2010","journal-title":"Surgery"},{"issue":"03","key":"ref15","doi-asserted-by":"crossref","first-page":"740","DOI":"10.1007\/s00586-021-06717-3","article-title":"Comparison of a dual-surgeon versus single-surgeon approach for scoliosis surgery: a systematic review and meta-analysis","volume":"30","author":"J W Hayes","year":"2021","journal-title":"Eur Spine J"},{"issue":"12","key":"ref16","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1097\/BRS.0000000000002070","article-title":"Results of the 2015 Scoliosis Research Society Survey on Single Versus Dual Attending Surgeon Approach for Adult Spinal Deformity Surgery","volume":"42","author":"J K Scheer","year":"2017","journal-title":"Spine"},{"issue":"01","key":"ref17","first-page":"48","article-title":"Two consultant spinal operating: operator perceived benefits","volume":"86","author":"J Macdonald","year":"2017","journal-title":"Ulster Med J"},{"issue":"02","key":"ref18","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1007\/s10549-020-05845-6","article-title":"The impact of co-surgeons on complication rates and healthcare cost in patients undergoing microsurgical breast reconstruction: analysis of 8680 patients","volume":"184","author":"M Asaad","year":"2020","journal-title":"Breast Cancer Res Treat"},{"issue":"04","key":"ref19","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1055\/s-0037-1598199","article-title":"Impact of continuous two-team approach in autologous breast reconstruction","volume":"33","author":"A J Bauermeister","year":"2017","journal-title":"J Reconstr Microsurg"},{"issue":"05","key":"ref20","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1002\/micr.30039","article-title":"Benefits of two or more senior microsurgeons operating simultaneously in microsurgical breast reconstruction: experience in a Swedish medical center","volume":"37","author":"N G\u00f6sseringer","year":"2017","journal-title":"Microsurgery"},{"issue":"01","key":"ref21","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1002\/micr.30191","article-title":"Co-surgeons in breast reconstructive microsurgery: What do they bring to the table?","volume":"38","author":"N T Haddock","year":"2018","journal-title":"Microsurgery"},{"issue":"02","key":"ref22","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1097\/PRS.0000000000008715","article-title":"Microvascular breast reconstruction in the era of value-based care: use of a cosurgeon is associated with reduced costs, improved outcomes, and added value","volume":"149","author":"A F Mericli","year":"2022","journal-title":"Plast Reconstr Surg"},{"issue":"09","key":"ref23","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1055\/s-0037-1604106","article-title":"The impact of the cosurgeon model on bilateral autologous breast reconstruction","volume":"33","author":"S N Razdan","year":"2017","journal-title":"J Reconstr Microsurg"},{"issue":"02","key":"ref24","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1097\/PRS.0000000000002946","article-title":"The impact of two operating surgeons on microsurgical breast reconstruction","volume":"139","author":"K E Weichman","year":"2017","journal-title":"Plast Reconstr Surg"},{"issue":"02","key":"ref25","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1097\/SAP.0000000000000559","article-title":"Optimizing efficiency in deep inferior epigastric perforator flap breast reconstruction","volume":"75","author":"O Canizares","year":"2015","journal-title":"Ann Plast Surg"},{"issue":"01","key":"ref26","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1186\/1471-2288-14-135","article-title":"Estimating the sample mean and standard deviation from the sample size, median, range and\/or interquartile range","volume":"14","author":"X Wan","year":"2014","journal-title":"BMC Med Res Methodol"},{"issue":"08","key":"ref27","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1016\/j.jclinepi.2006.11.003","article-title":"Effect sizes can be calculated for studies reporting ranges for outcome variables in systematic reviews","volume":"60","author":"S D Walter","year":"2007","journal-title":"J Clin Epidemiol"},{"key":"ref28","volume-title":"Statistical Power Analysis for the Behavioral Sciences","author":"J Cohen","year":"1988"},{"issue":"04","key":"ref29","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1055\/s-0039-1696998","article-title":"Finding consensus after two decades of breast implant-associated anaplastic large cell lymphoma","volume":"33","author":"M W Clemens","year":"2019","journal-title":"Semin Plast Surg"},{"issue":"01","key":"ref30","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1097\/SLA.0000000000002990","article-title":"US FDA breast implant postapproval studies: long-term outcomes in 99,993 patients","volume":"269","author":"C J Coroneos","year":"2019","journal-title":"Ann Surg"},{"issue":"09","key":"ref31","doi-asserted-by":"crossref","first-page":"e3801","DOI":"10.1097\/GOX.0000000000003801","article-title":"Efficient DIEP flap: bilateral breast reconstruction in less than four hours","volume":"9","author":"N T Haddock","year":"2021","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"04","key":"ref32","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1177\/1090820X14528503","article-title":"The impact of operative time on complications after plastic surgery: a multivariate regression analysis of 1753 cases","volume":"34","author":"K L Hardy","year":"2014","journal-title":"Aesthet Surg J"},{"issue":"01","key":"ref33","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1097\/PRS.0000000000007420","article-title":"A critical examination of length of stay in autologous breast reconstruction: a national surgical quality improvement program analysis","volume":"147","author":"V S Kotha","year":"2021","journal-title":"Plast Reconstr Surg"},{"issue":"01","key":"ref34","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.bjps.2019.06.019","article-title":"A structured pathway for accelerated postoperative recovery reduces hospital stay and cost of care following microvascular breast reconstruction without increased complications","volume":"73","author":"A C O'Neill","year":"2020","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"01","key":"ref35","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1007\/s10549-018-4991-8","article-title":"Enhanced recovery after surgery (ERAS) pathways in breast reconstruction: systematic review and meta-analysis of the literature","volume":"173","author":"A C Offodile II","year":"2019","journal-title":"Breast Cancer Res Treat"},{"issue":"12","key":"ref36","doi-asserted-by":"crossref","first-page":"e1588","DOI":"10.1097\/GOX.0000000000001588","article-title":"Examining length of hospital stay after microsurgical breast reconstruction: evaluation in a case-control study","volume":"5","author":"J D Frey","year":"2017","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"06","key":"ref37","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1016\/j.bjps.2018.02.018","article-title":"Cost analysis of enhanced recovery after surgery in microvascular breast reconstruction","volume":"71","author":"C Oh","year":"2018","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"04","key":"ref38","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1097\/PRS.0000000000004197","article-title":"Enhanced recovery pathway in microvascular autologous tissue-based breast reconstruction: Should it become the standard of care?","volume":"141","author":"C Kaoutzanis","year":"2018","journal-title":"Plast Reconstr Surg"},{"issue":"05","key":"ref39","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1016\/j.jamcollsurg.2020.01.035","article-title":"Time-driven activity-based costing to model cost utility of enhanced recovery after surgery pathways in microvascular breast reconstruction","volume":"230","author":"A F Mericli","year":"2020","journal-title":"J Am Coll Surg"},{"issue":"08","key":"ref40","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1055\/s-0039-1687916","article-title":"Reducing length of stay after microsurgical breast reconstruction with a standardized postoperative protocol","volume":"35","author":"M A DelMauro","year":"2019","journal-title":"J Reconstr Microsurg"},{"issue":"02","key":"ref41","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1016\/j.joms.2019.09.011","article-title":"Head and neck reconstructive surgery: characterization of the one-team and two-team approaches","volume":"78","author":"S J Torabi","year":"2020","journal-title":"J Oral Maxillofac Surg"},{"issue":"04","key":"ref42","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1055\/s-0040-1716404","article-title":"Intraoperative microvascular complications in autologous breast reconstruction: the effects of resident training on microsurgical outcomes","volume":"37","author":"S S Teotia","year":"2021","journal-title":"J Reconstr Microsurg"},{"issue":"04","key":"ref43","doi-asserted-by":"crossref","first-page":"717e","DOI":"10.1097\/PRS.0000000000006630","article-title":"Deconstructing the reconstruction: evaluation of process and efficiency in deep inferior epigastric perforator flaps","volume":"145","author":"N T Haddock","year":"2020","journal-title":"Plast Reconstr Surg"}],"container-title":["Journal of Reconstructive Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2253-6099.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T16:40:10Z","timestamp":1730824810000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2253-6099"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,24]]},"references-count":43,"journal-issue":{"issue":"08","published-online":{"date-parts":[[2024,9,12]]},"published-print":{"date-parts":[[2024,10]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2253-6099","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0743-684X","1098-8947"],"issn-type":[{"value":"0743-684X","type":"print"},{"value":"1098-8947","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,1,24]]},"published":{"date-parts":[[2024,1,24]]}}}