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Lean DIEP flap surgery: saving time and reducing complications

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European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

The number of performed deep inferior epigastric perforator (DIEP) flaps for post-mastectomy breast reconstructions (PMBR) has shown a dramatic increase over the past decade. As this increased demand requires a higher proportion of operative capacities worldwide, there is a need for increased efficiency. Introduction of lean strategies might form a solution. Therefore, the purpose of this study was to assess the effects and outcomes of practising lean strategies in DIEP flap surgery over six years by analysing operation time and complications.

Methods

In this retrospective cohort study, all patients who underwent a DIEP flap for PMBR between January 2013 and May 2019 were included. Patient- and surgery related characteristics were collected. Duration of surgery and complication rates were compared.

Results

A total of 170 DIEP flaps for PMBR were performed in 139 patients. DIEP flaps were performed in an immediate (8 patients) or delayed (131 patients) setting. Mean operating time was 329 minutes for unilateral and 554 minutes for bilateral DIEP flap reconstruction. Over time, operating time decreased 19% in the unilateral, and 17.1% in the bilateral series. Also, more additional procedures during the initial DIEP flap procedure were performed over time. Total flap loss was seen in 1.2% of the cases. While surgical time decreased, the number of major complications decreased 9.3% in the unilateral and 20% in the bilateral series.

Conclusions

Using lean strategies can safely reduce surgical time in DIEP flap breast reconstructions, while achieving, a reduction of complications.

Level of evidence: Level IV, risk/prognostic study.

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Acknowledgements

Anaesthetists (A.J. Jansen; A.F. van der Meer), nurse practitioner (C. van Zuuren), theatre staff (P. Kammerman, T. Kruiper, R. Leis-Dorenbusch, M. Dosoe, M. Postmus-Folkes, G. Kouwenhoven-Voortman, R. van Ommen-Schipper, A. Aaldering, B. van der Horst), and nursing staff.

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Authors and Affiliations

  1. Department of Plastic, Reconstructive and Hand Surgery, Ziekenhuis Groep Twente (ZGT), Geerdinksweg 141, 7555 DL, Almelo/Hengelo, The Netherlands

    Juliette E. D. Jacobs, Narda Hendriks-Brouwer, Oliver T. Zöphel, Ute Schmidbauer, Yvonne C. M. M. Smulders, Johan G. Wijbenga & Hinne A. Rakhorst

  2. Department of Plastic, Reconstructive and Hand Surgery, Isala, Zwolle, The Netherlands

    Nikki Beudeker

  3. Department of Plastic, Reconstructive and Hand Surgery & General Surgery, St. Antonius Hospital, Utrecht, The Netherlands

    Claudia A. Bargon

  4. Department of Health Technology and Services Research, Technical Medical Center, University of Twente, Enschede, The Netherlands

    Sabine Siesling

  5. Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands

    Sabine Siesling

Authors
  1. Juliette E. D. Jacobs
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  2. Nikki Beudeker
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  6. Oliver T. Zöphel
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  7. Ute Schmidbauer
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  8. Yvonne C. M. M. Smulders
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  9. Johan G. Wijbenga
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  10. Hinne A. Rakhorst
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Corresponding author

Correspondence to Juliette E. D. Jacobs.

Ethics declarations

Ethics 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. This study was approved by the regional Medical Ethics Committee, registration no.: K20-15.

Informed consent

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

Patient consent

Patients signed informed consent regarding publishing their data.

Conflict of interest

Juliette E.D. Jacobs, Nikki Beudeker, Claudia A. Bargon, Sabine Siesling, Narda Hendriks-Brouwer, Oliver T. Zöphel, Ute Schmidbauer, Yvonne C.M.M. Smulders, Johan G. Wijbenga, and Hinne A. Rakhorst declare no conflict of interest. The authors alone are responsible for the content and writing of the paper.

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Jacobs, J.E.D., Beudeker, N., Bargon, C.A. et al. Lean DIEP flap surgery: saving time and reducing complications. Eur J Plast Surg 44, 793–800 (2021). https://doi.org/10.1007/s00238-021-01836-y

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  • DOI: https://doi.org/10.1007/s00238-021-01836-y

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