# Coexisting in a Crowded Field: A 10-year Comparison of Procedural Volumes of Plastic Surgeons and Other Surgical Specialties in the United States

## TL;DR

This study compares plastic surgeons' procedural volumes with other surgical specialties in the U.S. over 10 years, finding plastic surgeons dominate in breast reconstruction and microsurgery.

## Contribution

The paper provides the first 10-year analysis of plastic surgery procedural volumes relative to other surgical specialties in the U.S.

## Key findings

- Plastic surgeons performed the majority of breast reconstruction and microsurgery procedures in 2010 and 2020.
- Plastic surgical involvement did not significantly decrease in any procedural category over the study period.
- Operative times and complication rates varied inversely with case numbers across specialties.

## Abstract

Plastic surgery has broad overlap with other surgical subspecialties. Regarding procedures provided by both plastic surgery and other surgical specialties in the United States, the changes in plastic surgical case volume over time have not been previously investigated.

Select common procedure terminology (CPT) codes from an array of areas of practice including breast reconstruction, hand, adult craniofacial, peripheral nerve, microsurgery, and ventral hernia were extracted from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) from 2010 to 2020. Case numbers, operative times, and complication rates among surgical subspecialties were compared. Aesthetic surgery cases were excluded as they are not well captured by the NSQIP database.

A total of 128,545 procedures were included. In 2010 and 2020, plastic surgeons performed 83.9% versus 89.3% of reconstructive breast (
p
 < 0.001), 5.4% versus 4.3% of hand (
p
 = 0.23), 33.6% versus 39.1% of adult craniofacial (
p
 = 0.28), 36.7% versus 29.5% of peripheral nerve (
p
 = 0.45), 9.3% versus 94.6% of microsurgical (
p
 = 0.25), and 0.4% versus 0.4% of ventral hernia procedures (
p
 = 0.99). Plastic surgery performed the majority of breast reconstruction and microsurgical procedures. Operative times and complication rates varied between specialties and were generally inversely proportional to the number of cases for included specialties.

Plastic surgical involvement did not significantly decrease for any of the included procedural categories in ACS-NSQIP over the study period. Breast reconstruction and microsurgery remain areas of particular specialization with plastic surgeons performing the highest volume. Areas of shared practice suggest opportunities for collaboration.