A Disappearing Act: Trends in Head and Neck Free Flap Reconstruction over the Last Decade
Geoffrey M Kozak1, Evan Katzel1, Jessica F Rose2, Liza C Wu1 1Division of Plastic Surgery, University of Pennsylvania, Philadelphia, PA, USA 2University of Texas Health Science Center, Houston, TX, USA
Background: Head and neck free flap (HNFF) reconstruction are complex cases often times requiring expertise in microvascular surgery. A multidisciplinary approach has historically been utilized between otolaryngologists (ENT) and plastic surgeons (PS), however, both the extirpative and reconstructive portions are now performed by ENT. We aim to elucidate the trend in volume of HNFF reconstruction over the last decade.
Methods: Data was collected from 2007 to 2017 by three modalities: electronic medical record (EMR) search of patients who underwent HNFF surgery at our institution, NSQIP query of cases receiving designated HNFF CPT codes, and survey data regarding volume from microsurgery fellowship program directors (MFPD). The data were analyzed with trends in HNFF reconstruction as our primary outcome.
Results: From 2013 to 2017 at our institution, the total number of HNFF microvascular reconstruction increased 4-fold (59 to 227). The percentage of cases by PS decreased from 18.6% to 6.0% while that of ENT increased 81.4% to 94.0% (p=0.009). Survey data, completed by 35 MFPD, revealed the number of ENT programs in 2007 performing ≥100 HNFF compared to PS was 40% to 12.5% (p=0.172). By 2016, that number increased significantly for ENT to 73.3% while that of PS remained stagnant at 12.5% (p=0.005). According to NSQIP data, from 2011 to 2016, HNFF volume for ENT trended up to 58% from 43% while that of PS trended down, 52% to 38% (p=0.003).
Conclusion: HNFF reconstruction has grown dramatically over the last ten years. Plastic surgeons are performing less cases while ENT performs more as indicated by institutional, microsurgery fellowship program director survey, and NSQIP data. Understanding volume trends allows residency and fellowship directors to address shortages in training curricula mandated by the ACGME.
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