Do adjunctive flap-monitoring technologies impact clinical decision making? An analysis of microsurgeon preferences and behavior by body region

Justin L. Bellamy, Gerhard S. Mundinger, José M. Flores, Eric G. Wimmers, Georgia C. Yalanis, Eduardo D. Rodriguez, Justin Michael Sacks

Research output: Contribution to journalArticle

Abstract

Background: Multiple perfusion assessment technologies exist to identify compromised microvascular free flaps. The effectiveness, operability, and cost of each technology vary. The authors investigated surgeon preference and clinical behavior with several perfusion assessment technologies. Methods: A questionnaire was sent to members of the American Society for Reconstructive Microsurgery concerning perceptions and frequency of use of several technologies in varied clinical situations. Demographic information was also collected. Adjusted odds ratios were calculated using multinomial logistic regression accounting for clustering of similar practices within institutions/regions. Results: The questionnaire was completed by 157 of 389 participants (40.4 percent response rate). Handheld Doppler was the most commonly preferred free flap-monitoring technology (56.1 percent), followed by implantable Doppler (22.9 percent) and cutaneous tissue oximetry (16.6 percent). Surgeons were significantly more likely to opt for immediate take-back to the operating room when presented with a concerning tissue oximetry readout compared with a concerning handheld Doppler signal (OR, 2.82; p <0.01), whereas other technologies did not significantly alter postoperative management more than simple handheld Doppler. Clinical decision making did not significantly differ by demographics, training, or practice setup. Conclusions: Although most surgeons still prefer to use standard handheld Doppler for free flap assessment, respondents were significantly more likely to opt for immediate return to the operating room for a concerning tissue oximetry reading than an abnormal Doppler signal. This suggests that tissue oximetry may have the greatest impact on clinical decision making in the postoperative period.

Original languageEnglish (US)
Pages (from-to)883-892
Number of pages10
JournalPlastic and Reconstructive Surgery
Volume135
Issue number3
DOIs
StatePublished - Mar 4 2015

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Body Regions
Oximetry
Free Tissue Flaps
Technology
Biomedical Technology Assessment
Operating Rooms
Transcutaneous Blood Gas Monitoring
Perfusion
Demography
Postoperative Period
Cost-Benefit Analysis
Cluster Analysis
Reading
Logistic Models
Odds Ratio
Clinical Decision-Making
Surgeons
Surveys and Questionnaires

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Do adjunctive flap-monitoring technologies impact clinical decision making? An analysis of microsurgeon preferences and behavior by body region. / Bellamy, Justin L.; Mundinger, Gerhard S.; Flores, José M.; Wimmers, Eric G.; Yalanis, Georgia C.; Rodriguez, Eduardo D.; Sacks, Justin Michael.

In: Plastic and Reconstructive Surgery, Vol. 135, No. 3, 04.03.2015, p. 883-892.

Research output: Contribution to journalArticle

Bellamy, Justin L. ; Mundinger, Gerhard S. ; Flores, José M. ; Wimmers, Eric G. ; Yalanis, Georgia C. ; Rodriguez, Eduardo D. ; Sacks, Justin Michael. / Do adjunctive flap-monitoring technologies impact clinical decision making? An analysis of microsurgeon preferences and behavior by body region. In: Plastic and Reconstructive Surgery. 2015 ; Vol. 135, No. 3. pp. 883-892.
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