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Immediate Reconstruction Swing Room Scheduling Reduces Wait Times to Surgery and Increases Breast Reconstruction Rates

  • Elaine McKevittEmail author
  • Urve Kuusk
  • Carol Dingee
  • Rebecca Warburton
  • Jin-Si Pao
  • Nancy Y. Van Laeken
  • Esta S. Bovill
Reconstructive Oncology

Abstract

Background

Despite benefits in quality of life, patient satisfaction, overall healthcare costs, and number of surgeries, historically fewer than 30% of patients undergo immediate breast reconstruction following mastectomy for breast cancer. A paucity of qualified oncologic and plastic surgeons coupled with inefficient use of operating room (OR) resources presents challenges in offering immediate breast reconstruction in a timely manner. To address these challenges, an immediate reconstruction swing room (IRSW) program was developed.

Methods

IRSW scheduling leverages two concurrently running ORs, with the surgical oncologist and plastic surgeon moving between rooms to complete 2–4 combined mastectomy cases with immediate reconstruction, in addition to 1–2 independent cases, each operative day. The final year of traditional booking was compared with IRSW scheduling to assess wait times and reconstruction rates.

Results

Comparing the 2 years, fewer surgical breast cases were performed with IRSW scheduling (1250 vs. 1178), however the overall number of oncology cases increased from 735 (59%) to 857 (73%). The number of immediate reconstructions performed increased from 75 to 139 (p < 0.0001), which reflects a mean of 1.2 IR cases versus 2.9 combined cases in IRSW. Overall, this facilitated an increase in the rate of immediate reconstruction following therapeutic mastectomy from 35 to 49% (p = 0.0004) and decreased wait times from core biopsy to surgery from 70 to 52 days (p < 0.0001).

Conclusions

A multidisciplinary model with optimized scheduling has the potential to improve resource utilization and access to breast cancer care.

Notes

Acknowledgements

The authors would like to acknowledge the Department of Surgery at PHC and the staff in the operating room for assistance in implementing the IRSW scheduling. We would also like to acknowledge Shangmei Hou, who helped with chart review and manuscript preparation.

Disclosures

The authors have no financial disclosures.

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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Elaine McKevitt
    • 1
    • 2
    Email author
  • Urve Kuusk
    • 1
    • 2
  • Carol Dingee
    • 1
    • 2
  • Rebecca Warburton
    • 1
    • 2
  • Jin-Si Pao
    • 1
    • 2
  • Nancy Y. Van Laeken
    • 1
    • 2
  • Esta S. Bovill
    • 1
    • 2
  1. 1.Department of SurgeryProvidence Breast CenterVancouverCanada
  2. 2.Department of SurgeryThe University of British ColumbiaVancouverCanada

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