Optimizing Surgical Outcomes and the Role of Preventive Surgery: A Scoping Review

Ryan P. Cauley; Benjamin Rahmani; Oluwaseun D. Adebagbo; John Park; Shannon R. Garvey; Amy Chen; Sasha Nickman; Micaela Tobin; Lauren Valentine; Allan A. Weidman; Dhruv Singhal; Arriyan Dowlatshahi; Samuel J. Lin; Bernard T. Lee

doi:10.1055/a-2331-7885

Journal of Reconstructive Microsurgery, Inhaltsverzeichnis

J Reconstr Microsurg 2025; 41(03): 248-260
DOI: 10.1055/a-2331-7885

Original Article

Optimizing Surgical Outcomes and the Role of Preventive Surgery: A Scoping Review

Ryan P. Cauley

¹Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts

,

Benjamin Rahmani

¹Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts

,

Oluwaseun D. Adebagbo

¹Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts

²Department of Surgery, Tufts University School of Medicine, Boston, Massachusetts

,

John Park

¹Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts

,

Shannon R. Garvey

¹Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts

,

Amy Chen

¹Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts

,

Sasha Nickman

¹Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts

,

Micaela Tobin

¹Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts

,

Lauren Valentine

¹Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts

,

Allan A. Weidman

¹Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts

,

Dhruv Singhal

¹Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts

,

Arriyan Dowlatshahi

¹Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts

,

Samuel J. Lin

¹Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts

,

Bernard T. Lee

¹Department of Surgery, Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts

› Institutsangaben

Abstract

Background Plastic and reconstructive surgeons are often presented with reconstructive challenges as a sequela of complications in high-risk surgical patients, ranging from exposure of hardware, lymphedema, and chronic pain after amputation. These complications can result in significant morbidity, recovery time, resource utilization, and cost. Given the prevalence of surgical complications managed by plastic and reconstructive surgeons, developing novel preventative techniques to mitigate surgical risk is paramount.

Methods Herein we aim to understand efforts supporting the nascent field of preventive surgery, including (1) enhanced risk stratification, (2) medical optimization and prehabilitation, (3) surgical mitigation techniques, and (4) advancements in postoperative care. Through an emphasis on four surgical cohorts who may benefit from preventive surgery, two of which are at high risk of morbidity from wound-related complications (patients undergoing sternotomy and spine procedures) and two at high risk of other morbidities, including lymphedema and neuropathic pain, we aim to provide a comprehensive and improved understanding of preventive surgery. Additionally, the role of risk analysis for these procedures and the relationship between microsurgery and prophylaxis is emphasized.

Results Although multiple risk mitigation methods have demonstrated clear benefits, including prophylactic surgical procedures and earlier involvement of plastic surgery, their use is widely variable across institutions. Many current risk assessment tools are suboptimal for supporting more algorithmic approaches to reduce surgical risk.

Conclusion Reconstructive surgeons are ideally placed to lead efforts in the creation and validation of accurate risk assessment tools and to support algorithmic approaches to surgical risk mitigation. Through a paradigm shift, including universal promotion of the concept of “Preventive Surgery,” major improvements in surgical outcomes may be achieved.

Keywords

preventive surgery - risk assessment - prehabilitation - microsurgery - reconstruction

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