Advertisement

Improving surgical efficiency of immediate implant-based breast reconstruction following mastectomy

  • Kassandra Nealon
  • Megan Rebello
  • Nikhil Sobti
  • Andrew Sherburne
  • Dale Spracklin
  • Eric C. Liao
  • Michelle SpechtEmail author
Clinical trial
  • 44 Downloads

Abstract

Purpose

Traditionally, during a mastectomy with implant-based reconstruction, the surgical oncologist completes their operative procedure prior to the reconstructive surgeon entering the room. In this scenario, two separate instruments kits and tables are utilized. In our institution, we created a combined instrument kit for use by both surgical teams. We compared set-up and operative times for each process and the subsequent savings associated with this novel approach.

Methods

Sixty-eight patients undergoing mastectomy with implant-based reconstruction were divided into two groups—those who underwent the procedure with separate oncology and reconstructive kits and those who underwent the procedure with combined instrumentation. Set-up time, procedure time, and clinical outcome endpoints were compared. Costs associated with each process were estimated.

Results

Surgical set-up time was lower using the combined kit versus separate kits [mean for unilateral cases, 25.1 ± 9.6 min vs. 35.7 ± 10.4 min (p < 0.01) and mean for bilateral cases, 33.1 ± 10.3 min vs. 43.5 ± 9.9 min (p = 0.31)]. Procedure time was significantly lower using the combined kit versus separate kits [mean for unilateral cases, 156.2 ± 31.7 min vs. 172.1 ± 33.0 min (p < 0.05) and mean for bilateral cases, 207.3 ± 39.3 min vs. 228. 8 ± 42.7 min (p = 0.03)]. Post-operative outcomes were not significantly different between the two groups at 6 months post-surgery (p = 0.72). Due to a decrease in operating room utilization and costs associated with instrumentation, we estimated $134,396 to $206,621 with unilateral cases and a $289,167 to $465,967 in yearly savings with bilateral cases by using the combined process.

Conclusion

Mastectomy with implant-based reconstruction utilizing combined instrumentation, with surgeons working simultaneously, led to decreased operating room utilization and costs without impacting clinical outcomes.

Level of evidence II

Keywords

Plastic surgery Surgical oncology Breast reconstruction Mastectomy Surgical efficiency Cost savings 

Notes

Compliance with ethical standards

Conflict of interest

Eric Liao M.D. Ph.D has consultant agreements but is explicitly not a speaker for Musculoskeletal Transplant Foundation and Allergan Inc., manufacturers of FlexHD and AlloDerm, respectively. No funds were received for this clinical study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    American Chemical Society (2017) Breast cancer facts & figure, 2017–2018Google Scholar
  2. 2.
    Surgeons ASoP (2017) 2017 plastic surgery statistics reportGoogle Scholar
  3. 3.
    Mhlaba JM et al (2015) Surgical instrumentation: the true cost of instrument trays and a potential strategy for optimization. J Hosp Adm 4(6):82–88Google Scholar
  4. 4.
    Farrelly JS et al (2017) Surgical tray optimization as a simple means to decrease perioperative costs. J Surg Res 220:320–326CrossRefGoogle Scholar
  5. 5.
    Farrokhi FR et al (2015) Application of lean methodology for improved quality and efficiency in operating room instrument availability. J Healthc Qual 37(5):277–286CrossRefGoogle Scholar
  6. 6.
    Stockert EW, Langerman A (2014) Assessing the magnitude and costs of intraoperative inefficiencies attributable to surgical instrument trays. J Am Coll Surg 219(4):646–655CrossRefGoogle Scholar
  7. 7.
    Rothstein DH, Raval MV (2018) Operating room efficiency. Semin Pediatr Surg 27:79–85CrossRefGoogle Scholar
  8. 8.
    Fong AJ, Smith M, Langerman A (2016) Efficiency improvement in the operating room. J Surg Res 204(2):371–383CrossRefGoogle Scholar
  9. 9.
    Chin CJ et al (2014) Reducing otolaryngology surgical inefficiency via assessment of tray redundancy. J Otolaryngol Head Neck Surg 43:46CrossRefGoogle Scholar
  10. 10.
    Lunardini D et al (2014) Lean principles to optimize instrument utilization for spine surgery in an academic medical center: an opportunity to standardize, cut costs, and build a culture of improvement. Spine 39(20):1714–1717CrossRefGoogle Scholar
  11. 11.
    Morris LF et al (2014) Streamlining variability in hospital charges for standard thyroidectomy: developing a strategy to decrease waste. Surgery 156(6):1441–1449 (Discussion 1449)CrossRefGoogle Scholar
  12. 12.
    Greenberg JA, Wylie B, Robinson JN (2012) A pilot study to assess the adequacy of the Brigham 20 Kit for cesarean delivery. Int J Gynaecol Obstet 117(2):157–159CrossRefGoogle Scholar
  13. 13.
    E.O.o.L.a.W Development (2017) Labor market information. Occupational Employment and Wage Statistics, Washington, DCGoogle Scholar
  14. 14.
    Childers CP, Maggard-Gibbons M (2018) Understanding costs of care in the operating room. JAMA Surg 153:e176233–e176233CrossRefGoogle Scholar
  15. 15.
    Shippert RD (2005) A study of time-dependent operating room fees and how to save $100 000 by using time-saving products. Am J Cosmet Surg 22(1):25–34CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Kassandra Nealon
    • 1
    • 2
  • Megan Rebello
    • 2
  • Nikhil Sobti
    • 2
  • Andrew Sherburne
    • 3
  • Dale Spracklin
    • 3
  • Eric C. Liao
    • 2
  • Michelle Specht
    • 1
    • 4
    Email author
  1. 1.Division of Surgical OncologyMassachusetts General HospitalBostonUSA
  2. 2.Division of Plastic and Reconstructive SurgeryMassachusetts General HospitalBostonUSA
  3. 3.Department of NursingMassachusetts General HospitalBostonUSA
  4. 4.BostonUSA

Personalised recommendations