The Value Of Process Analysis: A Multivariate Analysis Shows Immediate And Sustained Decrease In Morbidity And Operative Time
Nicholas T. Haddock, MD, John Tycher, BS, Edward Wen, BA, Sumeet S. Teotia, MD.
University of Texas Southwestern, Dallas, TX, USA.
PURPOSE: DIEP flaps are nuanced, multi-step procedures and it can be difficult for surgeons to focus on where to direct their efforts for true improvement. Recent studies have hinted that operational flow can be a sensitive barometer for safety, efficiency and aesthetic outcomes. Here we critically assess the utility of Process Analysis as a tool in the context of morbidity and operative time.
METHODS: Co-surgeons at a university hospital implemented two, prospective Process Analysis studies to carefully define and evaluate critical steps in DIEP flap reconstruction. During the 9-month period (June 2018 to February 2019), they assessed eight steps of flap harvest and microsurgery. During the 8-month period (January 2020 to August 2020), they expanded their analysis to encompass the entire operation. To evaluate the immediate and sustained impact of Process Analysis, we divided 375 bilateral DIEP flaps into eight, consecutive 9-month intervals completed before, during and after the two studies (April 2015 to August 2020). Using risk-adjusted multivariate regressions with a Helmert contrast, we compared morbidity and operative time between timing intervals.
RESULTS: Timing intervals completed prior to the 1st study had comparable morbidity and operative time. During the 1st study, there is an immediate 63.4% (P<.05) decrease in morbidity. The following 27-months show a sustained decrease in morbidity and operative time between each consecutive timing interval. The most significant decrease in operative time occurs during the 2nd study.
CONCLUSION: Process Analysis is a powerful tool capable of generating immediate and sustained decreases in morbidity and operative time.
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