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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.