Efficiency of microvascular free flap reconstructive surgery: An observational study

Bahethi, Rohini R.; Gold, Brandon; Seckler, Solomon G.; Kinberg, Eliezer; Stepan, Katelyn; Gray, Mark H.; DeMaría, Samuel; Miles, Brett A.

doi:10.1016/j.amjoto.2020.102692

Cited by 9 publications

(7 citation statements)

References 28 publications

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“…This resulted in an average pre-incisional process of 1.6 hours after induction. 23 These inefficiencies have been shown to improve with experience and surgical team familiarity that result in significant reductions in overall operative time. 24 Focus should be placed on improving consistency of approach and operative efficiency to better surgical outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…These cases have multiple phases, including pre-incision, extirpation and harvest, microvascular anastomosis, inset, and closure. In an observational study of operative efficiency in free flap reconstruction, Bahethi et al 23 identified about 20% of operative time was spent during the pre-incision process. Additionally, multiple room entries and exits occurred due to lack of preoperative communication about supply needs and surgical setup.…”

Section: Discussionmentioning

confidence: 99%

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Effect of 2 Teams and Operative Time on Complications After Oral Cavity Free Flap Reconstruction

Shaikh

Noor

Jafary

et al. 2023

Ann Otol Rhinol Laryngol

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Objective: Evaluate the effects of operative time and 2 team approach on complications after soft tissue free flap reconstruction for oral tongue cancer. Methods: Patients with oncologic glossectomy with myocutaneous or fasciocutaneous free flap reconstruction were included from the 2015 to 2018 American College of Surgery National Surgical Quality Improvement Program. The primary predictive variables assessed were operative time and 2 team approach; control variables included age, sex, body mass index (BMI), 5-question-modified frailty index (mFI-5), American Society of Anesthesiologists (ASA) class, and total work relative value units (wRVU). Outcomes assessed included 30-day mortality, 30-day reoperation, hospital length of stay beyond 30 days, readmission, medical and surgical complications, and non-home discharge. Multivariable logistic/linear regression models were used to predict surgical outcomes. Results: Microvascular soft tissue free flap reconstruction of the oral cavity after glossectomy was performed on 839 patients. Operative time was independently associated with readmission, prolonged length of stay, surgical complications, medical complications, and non-home discharge. A 2-team approach was independently associated with prolonged length of stay and medical complications. The mean operative time of the 1-team and 2-team approach was 8.73 and 9.13 hours. The 1-team approach did not significantly increase operative time ( P = .16). Conclusions: In the largest study to date of operative time on post-surgical outcomes after glossectomy and soft tissue free flap reconstruction, we found longer operative times increased rates of postoperative complications and non-home discharge. The 1-team approach is non-inferior to the 2-team approach with respect to operating time and complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effect of 2 Teams and Operative Time on Complications After Oral Cavity Free Flap Reconstruction

Shaikh

Noor

Jafary

et al. 2023

Ann Otol Rhinol Laryngol

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“…In an observational study of head and neck free-flap surgeries, 20% of operating room time was spent pre-incision, and an average of 270 entries and exits from the room occurred in each case, usually related to the need for supplies or communication purposes. 13 Operating room communication failures have been reported to occur in up to 30% of all operating room exchanges, compromising patient safety by increasing cognitive load, causing interruptions, and increasing tension. 14 Communication topics that increased operating room tension included: timing of elements of the procedure, safety and sterility, resources, and team roles; discussion of these topics have significant implications for team dynamics.…”

Section: Free-flap Plan Of the Daymentioning

confidence: 99%

“…Free‐flap reconstruction of the head and neck requires close teamwork between anesthesiologists, surgeons, nurses, and clinical operative services. In an observational study of head and neck free‐flap surgeries, 20% of operating room time was spent pre‐incision, and an average of 270 entries and exits from the room occurred in each case, usually related to the need for supplies or communication purposes 13 . Operating room communication failures have been reported to occur in up to 30% of all operating room exchanges, compromising patient safety by increasing cognitive load, causing interruptions, and increasing tension 14 .…”

Section: Free‐flap Plan Of the Daymentioning

confidence: 99%

Designing an evidence‐based free‐flap pathway in head and neck reconstruction

Mark

Eggerstedt

Urban

et al. 2022

World j. otorhinolaryngol.-head neck surg.

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Background: The use of autologous free-tissue transfer is an increasingly utilized tool in the ladder of reconstructive options to preserve and restore function in patients with head and neck cancer. This article focuses on the evidence surrounding perioperative care that optimizes surgical outcomes and describes one tertiary center's approach to standardized free-flap care.Data Sources: This article examines English literature from PubMed and offers expert opinion on perioperative free-flap care for head and neck oncology. Conclusion:Free-flap reconstruction for head and neck cancer is a process that, while individualized for each patient, is best supported by a comprehensive and standardized care pathway. Surgical optimization begins in the preoperative phase and a thoughtful approach to intraprofessional communication and evidence-based practice is rewarded with improved outcomes.

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“…Despite the significant body of research on gender differences in surgery, little is known about whether these differences exist in the inherently challenging and demanding field of microvascular reconstructive surgery. First described in the 1970s, microvascular (ie, free flap) tissue transfer has become an excellent modality for reconstruction of composite head and neck defects, with current flap survival rates exceeding 95% 17,18 . While free flap reconstruction can offer patients improved functional and aesthetic outcomes, such procedures are meticulous and time‐consuming, with an average operative time of 9 hours 18 .…”

mentioning

confidence: 99%

Gender Differences Among Head and Neck Microvascular Reconstructive Surgeons

Hobday

Armache

Frost

et al. 2023

Otolaryngol.--head neck surg.

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ObjectiveTo determine whether gender differences exist in the training history, practice patterns, and home lives of surgeons who perform microvascular reconstruction of the head and neck.Study DesignCross‐sectional survey.SettingMedical facilities that employ surgeons who practice head and neck microvascular reconstruction in the United States.MethodsA survey was created using the Research Electronic Data Capture Framework and was distributed via email to microvascular reconstructive surgeons. Descriptive statistics were performed using Stata software.ResultsNo significant differences were found in training or current practice patterns between microvascular surgeons who identify as men versus those who identify as women. Women had fewer children (p = .020) and were more likely to be childless (p = .002). Whereas men were more likely to report a spouse/partner as primary caretaker, women were more likely to hire a professional caretaker or cite themselves as a primary caretaker (p < .001). Women were more likely to have finished residency (p = .015) and fellowship (p = .014) more recently and to practice in the Southeast (p = .006). Of the microvascular surgeons who reported practice setting switches, men more commonly changed positions for career advancement, whereas women were more likely to switch due to burnout (p = .002).ConclusionThis study found no gender‐based differences in training or practice patterns. However, significant differences were identified in childbearing, family structure, geographic practice location, and motives for switching practice.

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Efficiency of microvascular free flap reconstructive surgery: An observational study

Cited by 9 publications

References 28 publications

Effect of 2 Teams and Operative Time on Complications After Oral Cavity Free Flap Reconstruction

Effect of 2 Teams and Operative Time on Complications After Oral Cavity Free Flap Reconstruction

Designing an evidence‐based free‐flap pathway in head and neck reconstruction

Gender Differences Among Head and Neck Microvascular Reconstructive Surgeons

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