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Page 6 of 12                                                                                 Haddock et al. Plast Aesthet Res 2024;11:47     https://dx.doi.org/10.20517/2347-9264.2024.60



                          Table 1. Systematic review of MABR and efficiency models

                                          Country,                                                                                                         Co-
                          Author, year                   Flap type            Number of flaps Study design Intervention                                               Outcomes measured
                                          length                                                                                                           surgery?
                          Elliott et al.,   United States, 3  ms-fTRAM        111               Retrospective  Standardization of operative sequence       N/A        Operative time, complications
                               [19]
                          2007            years                               (91 uni, 10 bi)
                          Lee et al.,     United States, 3  DIEP              225               Prospective    Intraoperative pathway - “relational        N/A        Operative time, complications, OR/hospital costs, OR
                               [38]
                          2008            years                               (pre-intervention:               coordination teamwork”                                 staff satisfaction surveys
                                                                              50 uni, 50 bi
                                                                              post-intervention:
                                                                              25 uni, 25 bi)
                          Canizares       United States, 6  DIEP              104               Retrospective  Standardization of operative sequence       N/A        Operative time
                                    [21]
                          et al., 2015    months                              (32 uni, 36 bi)
                          Marsh et al.,   United         DIEP                 163 flaps         Retrospective  Standardization of operative sequence       Yes        Operative time
                               [20]
                          2016            Kingdom, 12                         (laterality not
                                          months                              defined)
                          Hultman et al.,  United States, 5  “perforator flap breast  168       Prospective    Six-sigma interventions                     N/A        Operative time, LOS, complications, unplanned return
                               [33]
                          2016            years          reconstruction”      (undefined)                                                                             to OR, physician/hospital revenue, and revenue per
                                                                                                                                                                      minute of OR time
                          Shama et al.,   UK (duration   DIEP                 20                Prospective    Process mapping, standardization of operative   No     Operative time (each step)
                          2019            not stated)                         (unilateral)      cohort         sequence
                          Haddock &       United States,   DIEP               147               Prospective    Process mapping, standardization of operative   Yes    Operative time, complications
                          Teotia,         10 months                           (unilateral)                     sequence
                               [37]
                          2020
                          Haddock &       United States, 8  DIEP              100               Prospective    Process mapping, standardization of operative   Yes    Operative time, complications
                                     [57]
                          Teotia, 2021    months                              (bilateral)                      sequence
                          Easton et al.,   United States, 5  DIEP, TRAM, PAP,   32              Retrospective  Preoperative (clinic, IV access, markings,   Yes       Operative time, LOS, complications
                               [30]
                          2023            years          TUG                  (bilateral)                      blocks) & intraoperative (surgical teams,
                                                                                                               standardized instruments, etc.)
                          Haddock et al.,  United States,   DIEP              375               Retrospective  Process mapping                             Yes        Operative time, complications
                               [47]
                          2023            18 months                           (bilateral)
                          Todd et al.,    Canada (15     DIEP                 1056 flaps        Retrospective  Standardization of operative sequence, surgeon  Yes    # of cases, operative time, intraoperative variables,
                               [39]
                          2023            years)                              (416 uni, 320 bi)                experience                                             LOS, readmission rate



                          improved intraoperative efficiency. The term “efficiency” in the realm of healthcare often carries an unintended connotation, insinuating a trade-off between

                          the quality of patient care and cost/resource reduction. However, this perception is misguided; an emphasis on efficiency entails an organized approach that
                          minimizes waste and cultivates an environment dedicated to achieving optimal outcomes across all facets.
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