Subscribe to RSS
Quantifying Complications: An Analysis of Operative Time and Intraoperative Factors in Microsurgical Breast Reconstruction
Background Analysis of operative flow has been shown to improve efficiency in breast microsurgery. Both complex decision-making skills and technical mastery are required to overcome intraoperative challenges encountered during microsurgical reconstruction. Effects of intraoperative complications on operative time have not yet been reported.
Methods A retrospective chart review of microsurgical breast reconstructions by three surgeons between 2013–2020 analyzed operative variables and duration. Intraoperative complications were determined from the operative report. Correlations between continuous variables were determined using Spearman correlation coefficients. Nonparametric testing was used when comparing operative duration between groups.
Results Operative duration was analyzed for 547 autologous breast reconstruction cases; 210 reconstructions were unilateral and 337 were bilateral. Average operative duration was 471.2 SD 132.2 minutes overall (360.1 SD 100.5 minutes for unilateral cases and 530.5 SD 110.5 minutes for bilateral cases). Operative duration decreased with surgeon experience (r = -0.17, p< .001).
Regarding intraoperative complications, difficult donor dissection was correlated with an average operative duration increase of 91.7 minutes (n = 43, 7.9%, p< .001), pedicle injury with an additional 67.7 minutes (n = 19, 3.5%, p = .02) and difficult recipient vessel dissection with an increase of 63.0 minutes (n = 35, 6.4%, p = .003). Complications with anastomosis also showed a statistically significant increase in operative duration, with arterial complications resulting in an increase of 104.3 minutes (n = 41, 7.5%, p< .001) and venous complications resulting in an increase in 78.8 minutes (n = 32, 5.8%, p< .001). Intraoperative thrombus resulted in an increase of 125.5 minutes (n = 20, 3.7%, p< .001), and requiring alternative venous outflow added an average of 193.7 minutes (n = 8, 1.5%, p< .001).
Conclusion Intraoperative complications in autologous breast reconstruction significantly increase operative time. The greatest increase in operative time is seen with intraoperative thrombosis or requiring alternative venous outflow. As these complications are rarely encountered in breast microsurgery, opportunities for simulation and case-based practice exist to improve efficiency.
Keywordsmicrosurgery complications - operative time analysis - intraoperative complications - autologous breast reconstruction - microsurgery efficiency
Received: 14 October 2021
Accepted: 20 February 2022
Article published online:
30 May 2022
© 2022. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
- 1 Yun JH, Diaz R, Orman AG. Breast Reconstruction and Radiation Therapy. Cancer Contr 2018; 25 (01) 1073274818795489 DOI: 10.1177/1073274818795489.
- 2 Yueh JH, Slavin SA, Adesiyun T. et al. Patient satisfaction in postmastectomy breast reconstruction: a comparative evaluation of DIEP, TRAM, latissimus flap, and implant techniques. PlastReconstr Surg 2010; 125 (06) 1585-1595 DOI: 10.1097/PRS.0b013e3181cb6351.
- 3 Hu ES, Pusic AL, Waljee JF. et al. Patient-reported aesthetic satisfaction with breast reconstruction during the long-term survivorship Period. PlastReconstr Surg 2009; 124 (01) 1-8 DOI: 10.1097/PRS.0b013e3181ab10b2.
- 4 Schmauss D, Machens HG, Harder Y. Breast Reconstruction after Mastectomy. Front Surg 2016; 2: 71 DOI: 10.3389/fsurg.2015.00071.
- 5 Kaidar-Person O, Offersen BV, Boersma LJ. et al. A multidisciplinary view of mastectomy and breast reconstruction: Understanding the challenges. Breast 2021; 56: 42-52 DOI: 10.1016/j.breast.2021.02.004.
- 6 Panchal H, Matros E. Current Trends in Postmastectomy Breast Reconstruction. PlastReconstr Surg 2017; 140 (5S Advances in Breast Reconstruction) 7S-13S
- 7 Albornoz CR, Bach PB, Mehrara BJ. et al. A paradigm shift in U.S. Breast reconstruction: increasing implant rates. PlastReconstr Surg 2013; 131 (01) 15-23 DOI: 10.1097/PRS.0b013e3182729cde.
- 8 Kulkarni AR, Sears ED, Atisha DM, Alderman AK. Use of autologous and microsurgical breast reconstruction by U.S. plastic surgeons. PlastReconstr Surg 2013; 132 (03) 534-541 DOI: 10.1097/PRS.0b013e31829ae03e.
- 9 Hardy KL, Davis KE, Constantine RS. et al. The impact of operative time on complications after plastic surgery: a multivariate regression analysis of 1753 cases. Aesthet Surg J 2014; 34 (04) 614-622 DOI: 10.1177/1090820 × 14528503.
- 10 Peersman G, Laskin R, Davis J, Peterson MG, Richart T. Prolonged operative time correlates with increased infection rate after total knee arthroplasty. HSS J 2006; 2 (01) 70-72 DOI: 10.1007/s11420-005-0130-2.
- 11 Kessler S, Kinkel S, Käfer W, Puhl W, Schochat T. Influence of operation duration on perioperative morbidity in revision total hip arthroplasty. Acta OrthopBelg 2003; 69 (04) 328-333
- 12 Cho MJ, Teotia SS, Haddock NT. Predictors, Classification, and Management of Umbilical Complications in DIEP Flap Breast Reconstruction. PlastReconstr Surg 2017; 140 (01) 11-18 DOI: 10.1097/PRS.0000000000003450.
- 13 Laporta R, Longo B, Sorotos M, Farcomeni A, Amorosi V, Santanelli di Pompeo F. Time-dependent factors in DIEP flap breast reconstruction. Microsurgery 2017; 37 (07) 793-799 DOI: 10.1002/micr.30203.
- 14 Haddock NT, Dumestre DO, Teotia SS. Efficiency in DIEP Flap Breast Reconstruction: The Real Benefit of Computed Tomographic Angiography Imaging. PlastReconstr Surg 2020; 146 (04) 719-723 DOI: 10.1097/PRS.0000000000007148.
- 15 Bauermeister AJ, Zuriarrain A, Newman M, Earle SA, Medina III MA. Impact of Continuous Two-Team Approach in Autologous Breast Reconstruction. J ReconstrMicrosurg 2017; 33 (04) 298-304 DOI: 10.1055/s-0037-1598199.
- 16 Sbitany H, Mirzabeigi MN, Kovach SJ, Wu LC, Serletti JM. Strategies for recognizing and managing intraoperative venous congestion in abdominally based autologous breast reconstruction. PlastReconstr Surg 2012; 129 (04) 809-815 DOI: 10.1097/PRS.0b013e318244222d.
- 17 La Padula S, Hersant B, Noel W. et al. Use of the retrograde limb of the internal mammary vein to avoid venous congestion in DIEP flap breast reconstruction: Further evidences of a reliable and time-sparing procedure. Microsurgery 2016; 36 (06) 447-452 DOI: 10.1002/micr.30043.
- 18 Javid P, Aydın A, Mohanna PN, Dasgupta P, Ahmed K. Current status of simulation and training models in microsurgery: A systematic review. Microsurgery 2019; 39 (07) 655-668 DOI: 10.1002/micr.30513.
- 19 Dave A, Singhal M, Tiwari R, Chauhan S, De M. Effectiveness of a microsurgery training program using a chicken wing model. J Plast Surg Hand Surg 2021; •••: 1-7 DOI: 10.1080/2000656X.2021.1953043.
- 20 Sinik LM, Elver AE, Egan KG. et al. Autologous Breast Reconstruction in Massive Weight Loss Patients: Understanding Risks in a Growing Population. PlastReconstr Surg 2022
- 21 Canizares O, Mayo J, Soto E, Allen RJ, Sadeghi A. Optimizing Efficiency in Deep Inferior Epigastric Perforator Flap Breast Reconstruction. Ann Plast Surg 2015; 75 (02) 186-192 DOI: 10.1097/SAP.0000000000000559.
- 22 Haddock NT, Kayfan S, Pezeshk RA, Teotia SS. Co-surgeons in breast reconstructive microsurgery: What do they bring to the table?. Microsurgery 2018; 38 (01) 14-20 DOI: 10.1002/micr.30191.
- 23 Teotia SS, Dickey RM, Liu Y, Jayaraman AP, Haddock NT. Intraoperative Microvascular Complications in Autologous Breast Reconstruction: The Effects of Resident Training on Microsurgical Outcomes. J ReconstrMicrosurg 2021; 37 (04) 309-314 DOI: 10.1055/s-0040-1716404.
- 24 Daly LT, Doval AF, Lin SJ, Tobias A, Lee BT, Dowlatshahi AS. Role of CTA in Women with Abdominal Scars Undergoing DIEP Breast Reconstruction: Review of 1,187 Flaps. J ReconstrMicrosurg 2020; 36 (04) 294-300 DOI: 10.1055/s-0039-1701040.
- 25 Colakoglu S, Tebockhorst S, Freedman J. et al. CT angiography prior to DIEP flap breast reconstruction: a randomized controlled trial. J PlastReconstrAesthet Surg 2022; 75 (01) 45-51
- 26 Haddock NT, Teotia SS. Deconstructing the Reconstruction: Evaluation of Process and Efficiency in Deep Inferior Epigastric Perforator Flaps. PlastReconstr Surg 2020; 145 (04) 717e-724e DOI: 10.1097/PRS.0000000000006630.