{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:25:42Z","timestamp":1787009142620,"version":"build-2736575974"},"reference-count":29,"publisher":"Georg Thieme Verlag KG","issue":"07","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Microsurgical breast reconstruction is intraoperatively complex. Evidence of standardized workflows improving outcomes exists, but the impact of staffing cases with familiar personnel is not documented.<\/jats:p>\n                  <jats:p>All microsurgical breast reconstructions (July 2021\u2013June 2024) at our institution were analyzed for staff familiarity at granular time intervals (T0: setup to incision, T1-T3: each third of procedure). Staff were deemed \u201cunfamiliar\u201d if they staffed &lt;2 microsurgical breast reconstructions with the attending in past 4 months. Intraoperative setbacks included anastomotic revisions, vessel damage, switching recipient vessels, or mastectomy flap defect. Major complications included operative takeback or flap loss.<\/jats:p>\n                  <jats:p>Among 291 surgeries (5 attendings, 2 hospitals), 35.1% were immediate, 77.3% used standard hemiabdominal DIEP flaps, 58.4% were bilateral, and 49.5% had prior radiation. Intraoperative setbacks occurred in 19.7%, major complications in 7.4%, average duration was 631.6\u2009minutes, and supply costs averaged $5,216. Unfamiliar scrub-techs correlated with increased intraoperative setbacks (OR: 2.11, p\u2009&lt;\u20090.05), particularly in early time intervals (T1: 1.91, p\u2009=\u20090.06; T2: 2.09, p\u2009&lt;\u20090.05). Unfamiliar circulators correlated with increased supply costs (+12.2%, p\u2009&lt;\u20090.05), especially in later time intervals (T2: +12.2%, p\u2009&lt;\u20090.05; T3: +16.0%, p\u2009&lt;\u20090.05). In addition to staff familiarity, at univariate level, intraoperative setbacks also correlated with prior radiation (p\u2009&lt;\u20090.05), duration correlated with laterality, immediate reconstructions, mastectomy type, and anastomoses (p\u2009&lt;\u20090.05), and costs correlated with anastomoses (p\u2009&lt;\u20090.05). Multivariate analysis confirmed unfamiliar scrub-techs and circulators were significantly correlated with increased intraoperative setbacks and higher costs (p\u2009&lt;\u20090.05), with a trend toward longer duration (p\u2009=\u20090.06).<\/jats:p>\n                  <jats:p>In microsurgical breast reconstruction, unfamiliar teams correlated with increased intraoperative setbacks, costs, and durations. Adjusting staffing models to prioritize familiarity may provide medical, financial, and logistical benefits.<\/jats:p>","DOI":"10.1055\/a-2717-4665","type":"journal-article","created":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:12:09Z","timestamp":1760137929000},"page":"602-611","source":"Crossref","is-referenced-by-count":0,"title":["Keep Your Friends Close and Your Teammates Closer: The Impact of Staffing with Familiar Personnel in Microsurgical Breast Reconstruction"],"prefix":"10.1055","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0266-122X","authenticated-orcid":false,"given":"Pranav N.","family":"Haravu","sequence":"additional","affiliation":[{"name":"Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, North Carolina, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenny A.","family":"Foster","sequence":"additional","affiliation":[{"name":"Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, North Carolina, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brett T.","family":"Phillips","sequence":"additional","affiliation":[{"name":"Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Health System, Durham, North Carolina, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,10,28]]},"reference":[{"key":"ref1","volume-title":"Breast Reconstruction Free Flaps","author":"J Rose","year":"2023"},{"issue":"08","key":"ref2","first-page":"e43855","article-title":"Current trends in autologous breast reconstruction and the implications of impending changes to insurance reimbursement","volume":"15","author":"A J 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