Streamlining and Consistency in Surgery: Lean-Six-Sigma to Improve Operating Room Efficiency

PURPOSE: Improving peri-operative efficiency helps reduce unnecessary surgical expenditure, increase operating room (OR) throughput, improve patient safety, and enhance staff and patient satisfaction. Lean Six-Sigma (LSS) is a quality improvement model that has been successfully applied to eliminate inefficiencies in the business sector but has not yet been widely adopted in medicine. This study investigates the adaptation of LSS improving operative efficiency for plastic surgery procedures. METHOD: The authors followed the Define, Measure, Analyze, Improve, and Control (DMAIC) phases to implement LSS. The key outcome measures gathered were operative times, including the cut-to-close time and the total time the patient spent in the operating room. RESULTS: The study included a total of 181 patients who underwent immediate bilateral DIEP flap breast reconstruction between January 2016 and December 2019. The LSS interventions were associated with a decrease in total operative time from 636.36 minutes to 530.35 minutes, and a decrease in the time between incision to closure from 555.16 minutes to 458.85 minutes for a bilateral mastectomy with immediate DIEP flap breast reconstruction. CONCLUSION: This study demonstrates that Lean-Six-Sigma is useful to improve peri-operative efficiency during complex plastic surgery procedures. The workflow of the procedure was improved by determining the optimal spatial positioning and distinct roles for each surgeon and preparing surgeon-specific surgical trays. Two process maps were developed to visualize the positioning of the surgeons during each stage of the procedure and depict the parallel workflow that helped improve intraoperative efficiency.