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Cited by 33Healthcare Operations and Scheduling OptimizationHealthcare Quality and ManagementReconstructive Surgery and Microvascular Techniques

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Implementation and Analysis of a Lean Six Sigma Program in Microsurgery to Improve Operative Throughput in Perforator Flap Breast Reconstruction

Hultman, Charles Scott, Kim, Sendia, Lee, Clara N., Wu, Cindy, Dodge, Becky, Hultman, Chloe Elizabeth, Roach, S. Tanner, Halvorson, Eric G.·2016·Annals of Plastic Surgery
DOI 10.1097/sap.0000000000000786
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Abstract

PURPOSE: Perforator flaps have become a preferred method of breast reconstruction but can consume considerable resources. We examined the impact of a Six Sigma program on microsurgical breast reconstruction at an academic medical center. METHODS: Using methods developed by Motorola and General Electric, we applied critical pathway planning, workflow analysis, lean manufacturing, continuous quality improvement, and defect reduction to microsurgical breast reconstruction. Primary goals were to decrease preoperative-to-cut time and total operative time, through reduced variability and improved efficiency. Secondary goals were to reduce length of stay, complications, and reoperation. The project was divided into 3 phases: (1) Pre-Six Sigma (24 months), (2) Six Sigma (10 months), (3) and Post-Six Sigma (24 months). These periods (baseline, intervention, control) were compared by Student t test and χ analysis. RESULTS: Over a 5-year period, 112 patients underwent 168 perforator flaps for breast reconstructions, by experienced microsurgeons. Total operative time decreased from 714 to 607 minutes (P < 0.01), across the study period, with the greatest drop occurring in unilateral cases, from 672 to 498 minutes (P < 0.01). Length of stay decreased from 6.3 to 5.2 days (P = 0.01). Overall complication rates (35.9% vs 30%, not significant) and take-back rates (20.5% vs 23.9%, not significant) remained similar over the 5-year period. Physician revenue/minute increased from US $6.28 to US $7.59, whereas hospital revenue/minute increased from US $21.84 to US $25.11. CONCLUSIONS: A Six Sigma program in microsurgical breast reconstruction was associated with better operational and financial outcomes. These incremental gains were maintained over the course of the study, suggesting that these benefits were due, in part, to process improvements. However, continued reductions in total operative time and length of stay, well after the intervention period, support the possibility that "learning curve" phenomenon may have contributed to the improvement in these outcomes.

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Research works printed but not linked: 25

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Metadata

Authors
Hultman, C. S., Kim, S., Lee, C. N., Wu, C., Dodge, B., Hultman, C. E., Roach, S. T., & Halvorson, E. G.
Affiliations
  • Brigham and Women's Hospital (US)
  • University of North Carolina Health Care (US)
ORCID
Lee, Clara N.
Venue
Annals of Plastic Surgery
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2016-06
Volume
76
Issue
Supplement 4
Pages
S352-S356
ISSN
0148-7043 (ISSN-L)
DOI
10.1097/sap.0000000000000786
OpenAlex
W2397857202
Cited by
33
References
0
Citations by year
2026: 3 · 2025: 1 · 2024: 7 · 2023: 1 · 2022: 7 · 2021: 3 · 2020: 4 · 2019: 2 · 2017: 2 · 2016: 2
FWCI
3.45
Type
journal article
Language
en
Open access
closed
Locations
  • Annals of Plastic Surgery (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Decision Sciences › Management Science and Operations Research › Healthcare Operations and Scheduling Optimization
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Quality and Management
  • Health Sciences › Medicine › Surgery › Reconstructive Surgery and Microvascular Techniques
Keywords
Six Sigma, lean manufacturing, microsurgical breast reconstruction, perforator flap, operative time, length of hospital stay, workflow analysis, continuous quality improvement, learning curve, hospital revenue, surgical efficiency
MeSH terms
Academic Medical Centers, Adult, Aged, Efficiency, Female, Humans, Microsurgery, Middle Aged, North Carolina, Mammaplasty, Workflow, Quality Improvement, Perforator Flap, Operative Time

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