Efficiency of microvascular free flap reconstructive surgery: An observational study

Area of Science:

• Microsurgery
• Surgical Workflow Analysis
• Quality Improvement Science

Background:

• Microvascular free flaps are complex procedures requiring optimized operative workflow.
• Lean principles offer a framework for enhancing efficiency in surgical settings.
• Direct observational studies are valuable for assessing real-world surgical processes.

Purpose of the Study:

• To evaluate the operative workflow and efficiency of microvascular free flaps using direct observation.
• To identify bottlenecks and areas for improvement in the surgical process.
• To apply Lean quality improvement (QI) principles to enhance surgical efficiency.

Main Methods:

• Direct observation of 23 microvascular free flap procedures.
• Documentation of pre-operative preparation and surgical duration.
• Recording and classification of operating room (OR) staff traffic patterns (entries/exits) by role and reason.
• Utilizing institutional surgical tracking database and chart review for supplemental data.

Main Results:

• Mean surgical time was 9.0 hours.
• The pre-incision period constituted approximately 20% of OR time (1.6 hours/case).
• One-third of OR entries/exits occurred during the pre-incision phase; common reasons were supplies and communication.

Conclusions:

• Comprehensive workflow studies of free flaps are feasible despite lengthy procedure times.
• Significant OR time is dedicated to the pre-incision period, primarily due to supply and communication inefficiencies.
• The findings provide a basis for QI interventions and establish a model for assessing surgical efficiency.