Late-Start Days Increase Total Operative Time in Microvascular Breast Reconstruction

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

• References

• 1 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 (1) 70-72
• 2 Kessler S, Kinkel S, Käfer W, Puhl W, Schochat T. Influence of operation duration on perioperative morbidity in revision total hip arthroplasty. Acta Orthop Belg 2003; 69 (4) 328-333
• 3 Castillo A, Zarak A, Kozol RA. Does a new surgical residency program increase operating room times?. J Surg Educ 2013; 70 (6) 700-702
• 4 Chamberlain RS, Patil S, Minja EJ, Kordears IV K. Does residents' involvement in mastectomy cases increase operative cost? If so, who should bear the cost?. J Surg Res 2012; 178 (1) 18-27
• 5 Heslin MJ, Doster BE, Daily SL , et al. Durable improvements in efficiency, safety, and satisfaction in the operating room. J Am Coll Surg 2008; 206 (5) 1083-1089 , discussion 1089–1090
• 6 Hoyt DB. Looking forward. Education: one of the four pillars of the American College of Surgeons. Bull Am Coll Surg 2014; 99 (11) 8-9
• 7 Healy C, Allen Sr RJ. The evolution of perforator flap breast reconstruction: twenty years after the first DIEP flap. J Reconstr Microsurg 2014; 30 (2) 121-125
• 8 Lee BT, Tobias AM, Yueh JH , et al. Design and impact of an intraoperative pathway: a new operating room model for team-based practice. J Am Coll Surg 2008; 207 (6) 865-873
• 9 Gawande Atul. Checklist Manifesto: How to Get Things Right. New York, NY: Metropolitan Books; 2010
• 10 Jandali S, Wu LC, Vega SJ, Kovach SJ, Serletti JM. 1000 consecutive venous anastomoses using the microvascular anastomotic coupler in breast reconstruction. Plast Reconstr Surg 2010; 125 (3) 792-798
• 11 Babineau TJ, Becker J, Gibbons G , et al. The “cost” of operative training for surgical residents. Arch Surg 2004; 139 (4) 366-369 , discussion 369–370
• 12 Chatterjee A, Chen L, Goldenberg EA, Bae HT, Finlayson SR. Opportunity cost in the evaluation of surgical innovations: a case study of laparoscopic versus open colectomy. Surg Endosc 2010; 24 (5) 1075-1079
• 13 Chatterjee A, Payette MJ, Demas CP, Finlayson SR. Opportunity cost: a systematic application to surgery. Surgery 2009; 146 (1) 18-22
• 14 Kodali BS, Kim D, Bleday R , et al. Successful strategies for the reduction of operating room turnover times in a tertiary care academic medical center. J Surg Res 2013; ; [Epub ahead of print]
• 15 Ginsburg PB. Controlling health care costs. N Engl J Med 2004; 351 (16) 1591-1593