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A Standardized Operative Team for Major Head and Neck Cancer Ablation and Reconstruction

Doherty, Christopher M.D., M.P.H.; Nakoneshny, Steven C. B.Sc.; Harrop, Allan R. M.D., M.Sc.; Matthews, T. Wayne M.D.; Schrag, Christiaan M.D.; McKenzie, David C. M.D.; De Haas, William M.D.; Davis, Roger B. Sc.D.; Dort, Joseph C. M.D., M.Sc.

Plastic and Reconstructive Surgery: July 2012 - Volume 130 - Issue 1 - p 82–88
doi: 10.1097/PRS.0b013e3182547e22
Reconstructive: Head and Neck: Original Articles

Background: Prolonged procedure time in head and neck cancer ablation and free flap reconstruction cases has been shown to significantly increase perioperative complications. The authors' objective was to evaluate the effectiveness of a standardized surgical nursing team for head and neck cancer ablation and free flap reconstruction operations for reducing procedure time.

Methods: A retrospective cohort analysis of consecutive patients presenting for head and neck cancer ablation and free flap reconstruction between January 1, 2007, and September 1, 2010, was performed. A standardized head and neck surgical nursing team was introduced on May 1, 2009, at our center. Procedure time and case time were measured before and after the introduction of the team. Univariable analyses were performed to evaluate the difference in procedure and case time between the two cohorts. A multivariable linear regression model was developed to control for confounding variables.

Results: There were 52 cases before the team was introduced and 49 cases after. Mean procedure time was reduced by 47.1 minutes (p = 0.04) and mean case time was reduced by 68.9 minutes (p = 0.01) after team introduction. The multivariable linear regression analysis demonstrated a significant reduction in operative time after team introduction, controlling for confounding variables.

Conclusions: The introduction of a standardized surgical nursing team led to a significant reduction in procedure and case time. A standardized team approach improves operating room efficiency in complex cases such as free flap reconstruction following tumor ablation.


Calgary, Alberta, Canada; and Boston, Mass.

From the Sections of Plastic Surgery and Otolaryngology–Head and Neck Surgery, Department of Surgery, University of Calgary, and the Harvard School of Public Health, Harvard University.

Received for publication January 23, 2012; accepted February 2, 2012.

Presented at the 2011 Annual Meeting of the Canadian Society of Plastic Surgery, in Vancouver, British Columbia, Canada, May 21 through 22, 2011, and oral practicum defense for M.P.H. at Harvard University, Boston, Massachusetts, July of 2011.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Christopher Doherty, M.D., M.P.H.; University of Calgary, Faculty of Medicine, HRIC 2A02, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada,

©2012American Society of Plastic Surgeons