Keep your friends close and your teammates closer: the impact of staffing with familiar personnel in microsurgical breast reconstruction

Background 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. Methods All microsurgical breast reconstructions (07/2021-06/2024) 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 "unfamiliar" if they staffed <2 microsurgical breast reconstructions with the attending in past four months. Intraoperative setbacks included anastomotic revisions, vessel damage, switching recipient vessels, or mastectomy flap defect. Major complications included operative takeback or flap loss. Results 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 minutes, and supply costs averaged $5,216. Unfamiliar scrub-techs correlated with increased intraoperative setbacks (OR:2.11,p<0.05), particularly in early time-intervals (T1:1.91,p=0.06; T2:2.09,p<0.05). Unfamiliar circulators correlated with increased supply costs (+12.2%,p<0.05), especially in later time-intervals (T2:+12.2%,p<0.05;T3:+16.0%,p<0.05). In addition to staff familiarity, at univariate level, intraoperative setbacks also correlated with prior radiation (p<0.05), duration correlated with laterality, immediate reconstructions, mastectomy type, and anastomoses (p<0.05), and costs correlated with anastomoses (p<0.05). Multivariate analysis confirmed unfamiliar scrub-techs and circulators were significantly correlated with increased intraoperative setbacks and higher costs (p<0.05), with a trend toward longer duration (p=0.06). Conclusion 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.