Team Consistency in Reducing Operative Time in Head and Neck Surgery with Microvascular Free Flap Reconstruction.

Abstract

To evaluate the impact of consistent surgical teams on procedure duration in head and neck free tissue transfer, and to evaluate the length of stay and readmission rates with consistent teams. A retrospective chart review of head and neck microvascular reconstruction by a single surgeon between August 2017 and November 2021 was performed. Procedure duration, wound complications, length of stay, and 30-day readmissions were analyzed. One circulating nurse (CN) and surgical technologist (ST) were considered "consistent" due to their prior work with the primary surgeon. All others were considered "ad hoc." Teams were "Consistent CN + ST," "Consistent ST," "Consistent CN," or "Ad hoc." Procedure duration between groups was compared via analysis of variance. Multivariate linear regression was performed to predict procedure duration. A total of 135 patients were included. Age, sex, and American Society of Anesthesiologists status did not significantly differ across groups (p=0.963; p=0.467; p=0.908, respectively). The mean procedure duration was 339.3 min and differed significantly across all groups (p=0.006, Cohen d=0.32). Compared to the Ad hoc group, consistent teams demonstrated significant reductions in mean procedure duration (Consistent CN + ST: 58.4 min, p=0.001, Cohen d=0.67; Consistent ST: 51.6 min, p=0.013, Cohen d=0.61; Consistent CN: 44.5 min, p=0.031, Cohen d=0.52). Controlling for other factors, the ad hoc team predicted increased procedure duration on multivariate analysis ( 57.38, 19.92-94.85, p < 0.003). Wound complications, length of stay, and readmission rates did not differ significantly across groups (p=0.940; p=0.174; p=0.935, respectively). Consistent CN and ST improve operative efficiency in head and neck-free tissue transfer. Future studies may evaluate the impact of team consistency on complications, physician burnout, and health systems costs. 3 Laryngoscope, 133:2154-2159, 2023.