Efficiency of microvascular free flap reconstructive surgery: An observational study

Rohini R. Bahethi*, Brandon S. Gold, Solomon G. Seckler, Eliezer Kinberg, Katelyn O. Stepan, Mingyang L. Gray, Samuel DeMaria, Brett A. Miles

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Objective: We aimed to assess operative workflow and efficiency in microvascular free flaps via a direct observational study based on Lean principles of quality improvement (QI). Methods: Observers monitored the workflow of twenty-three free flaps. Pre-operative preparation and surgical duration was recorded with supplemental data provided from our institution's surgical tracking database. Traffic patterns of operating room (OR) staff were documented as “entries” and “exits” from the OR and classified by role and the reason that the entry or exit was required. Patient data was obtained via chart review. Results: The mean surgical time was 9.0 h. Approximately 20% of OR time was dedicated to the pre-incision process, averaging 1.6 h per case. One third of entries and exits occurred during this period. In total, 180.2 surgical hours were observed during which 6215 “entries” and “exits” occurred. The mean number of entries and exits per case was 270; the most common reasons were supplies and communication. No association was observed between elapsed surgical time or total number of entries and exits with post-operative infection rates. Conclusion: Comprehensive observational workflow studies of free flaps are challenging to execute due to lengthy procedure times. At our high-volume institution, a significant portion of OR time is devoted to the pre-incision period, largely due to inadequate supply availability and pre-operative communication. These findings will serve as a foundation for QI interventions at our institution, while our observational model provides a broadly applicable framework for assessing surgical efficiency.

Original languageEnglish (US)
Article number102692
JournalAmerican Journal of Otolaryngology - Head and Neck Medicine and Surgery
Issue number6
StatePublished - Nov 1 2020


  • Communication
  • Free flap reconstruction
  • Microvascular surgery
  • Operating room efficiency
  • Operating room optimization
  • Quality improvement
  • Supplies
  • Teamwork

ASJC Scopus subject areas

  • Otorhinolaryngology


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