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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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