Abstract
Background
Microsurgical breast reconstruction is intraoperatively complex. Evidence of standardized
workflows improving outcomes exists, but the impact of staffing cases with familiar
personnel is not documented.
Methods
All microsurgical breast reconstructions (July 2021–June 2024) at our institution
were analyzed for staff familiarity at granular time intervals (T0: setup to incision, T1-T3: each third of procedure). Staff were deemed “unfamiliar” if they staffed <2 microsurgical
breast reconstructions with the attending in past 4 months. Intraoperative setbacks
included anastomotic revisions, vessel damage, switching recipient vessels, or mastectomy
flap defect. Major complications included operative takeback or flap loss.
Results
Among 291 surgeries (5 attendings, 2 hospitals), 35.1% were immediate, 77.3% used
standard hemiabdominal DIEP flaps, 58.4% were bilateral, and 49.5% had prior radiation.
Intraoperative setbacks occurred in 19.7%, major complications in 7.4%, average duration
was 631.6 minutes, and supply costs averaged $5,216. Unfamiliar scrub-techs correlated
with increased intraoperative setbacks (OR: 2.11, p < 0.05), particularly in early time intervals (T1: 1.91, p = 0.06; T2: 2.09, p < 0.05). Unfamiliar circulators correlated with increased supply costs (+12.2%, p < 0.05), especially in later time intervals (T2: +12.2%, p < 0.05; T3: +16.0%, p < 0.05). In addition to staff familiarity, at univariate level, intraoperative setbacks
also correlated with prior radiation (p < 0.05), duration correlated with laterality, immediate reconstructions, mastectomy
type, and anastomoses (p < 0.05), and costs correlated with anastomoses (p < 0.05). Multivariate analysis confirmed unfamiliar scrub-techs and circulators were
significantly correlated with increased intraoperative setbacks and higher costs (p < 0.05), with a trend toward longer duration (p = 0.06).
Conclusion
In microsurgical breast reconstruction, unfamiliar teams correlated with increased
intraoperative setbacks, costs, and durations. Adjusting staffing models to prioritize
familiarity may provide medical, financial, and logistical benefits.
Keywords
teaming - operating room efficiency - microsurgical breast reconstruction - cost saving
- intraoperative setbacks - complications
