Lean DIEP flap surgery: saving time and reducing complications

Abstract

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. 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. 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. 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.