Abstract
Background Prolonged operative time has been associated with increased postoperative complications
and higher costs. Many academic centers have a designated day for didactics that cause
cases to start 1 hour later. The purpose of this study is to analyze the late-start
effect of microvascular breast reconstructions on operative duration.
Methods A retrospective review was performed on all patients who underwent abdomina-based
free flap breast reconstruction from 2007 to 2011 and analyzed by those who had surgery
on late-start versus normal-start days. Patient demographics, average operative time,
postoperative complications, and individual surgeon effects were analyzed. A Student
t-test was used to compare operative times with statistical significance set at p < 0.05. A multivariate regression analysis was performed to control for potential
confounders.
Results A total of 272 patients underwent 461 free flap breast reconstructions. Twenty-one
cases were performed on late-start days and 251 cases were performed on normal-start
days. Patient demographics and complications were not statistically different between
the groups. The average operative time for all reconstructions was 434.3 minutes.
The average operative times were significantly longer for late-start days, 517.6 versus
427.3 minutes (p = 0.002). This was true for both unilateral and bilateral reconstructions (432.8
vs. 350.9 minutes, p = 0.05; 551.5 vs. 461.2 minutes, p = 0.007). There were no differences in perioperative complications and multivariate
regression showed no statistically significant relationship of confounders to duration
of surgery.
Conclusion Starting cases 1 hour later can increase operative times. Although outcomes were
not affected, we recommend avoiding lengthy procedures on late-start days.
Keywords
breast reconstruction - free flap - microvascular - free tissue transfer - autologous
breast reconstruction - operative time - late-start - operative duration - OR time
