Keep Your Friends Close and Your Teammates Closer: The Impact of Staffing with Familiar Personnel in Microsurgical Breast Reconstruction.

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.

Duke Scholars

Author Brett Thomas Phillips Surgery, Plastic, Maxillofacial, and Oral Surgery