title: Late-Start Days Increase Total Operative Time in Microvascular Breast Reconstruction.
abstract: BACKGROUND
  Prolonged operative time has been associated with increased postoperative complications and higher costs. Many academic centers have a designated day for didactics that cause cases to start 1 hour later. The purpose of this study is to analyze the late-start effect of microvascular breast reconstructions on operative duration.
  
  
  METHODS
  A retrospective review was performed on all patients who underwent abdomina-based free flap breast reconstruction from 2007 to 2011 and analyzed by those who had surgery on late-start versus normal-start days. Patient demographics, average operative time, postoperative complications, and individual surgeon effects were analyzed. A Student t-test was used to compare operative times with statistical significance set at p < 0.05. A multivariate regression analysis was performed to control for potential confounders.
  
  
  RESULTS
  A total of 272 patients underwent 461 free flap breast reconstructions. Twenty-one cases were performed on late-start days and 251 cases were performed on normal-start days. Patient demographics and complications were not statistically different between the groups. The average operative time for all reconstructions was 434.3 minutes. The average operative times were significantly longer for late-start days, 517.6 versus 427.3 minutes (p = 0.002). This was true for both unilateral and bilateral reconstructions (432.8 vs. 350.9 minutes, p = 0.05; 551.5 vs. 461.2 minutes, p = 0.007). There were no differences in perioperative complications and multivariate regression showed no statistically significant relationship of confounders to duration of surgery.
  
  
  CONCLUSIONS
  Starting cases 1 hour later can increase operative times. Although outcomes were not affected, we recommend avoiding lengthy procedures on late-start days.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Chu
authors.affiliation: Department of Plastic and Reconstructive Surgery, Institute of Reconstructive Plastic Surgery, New York University Medical Center, New York.
authors.forename: Jason S
authors.initials: JS
authors.lastname: Barr
authors.affiliation: Department of Plastic and Reconstructive Surgery, Institute of Reconstructive Plastic Surgery, New York University Medical Center, New York.
authors.forename: J Bradford
authors.initials: JB
authors.lastname: Hill
authors.affiliation: Division of Plastic and Reconstructive Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York.
authors.forename: Katie E
authors.initials: KE
authors.lastname: Weichman
authors.affiliation: Department of Plastic and Reconstructive Surgery, Institute of Reconstructive Plastic Surgery, New York University Medical Center, New York.
authors.forename: Nolan S
authors.initials: NS
authors.lastname: Karp
authors.affiliation: Department of Plastic and Reconstructive Surgery, Institute of Reconstructive Plastic Surgery, New York University Medical Center, New York.
authors.forename: Jamie P
authors.initials: JP
authors.lastname: Levine
mesh_terms: D005260:Female; D006801:Humans; D007318:Inservice Training; D016462:Mammaplasty; D008866:Microsurgery; D008875:Middle Aged; D009873:Operating Rooms / Q000458:organization & administration*; D061646:Operative Time; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies