Balancing Operative Efficiency and Surgical Education: A Functional Neurosurgery Model

Area of Science:

• Neurosurgery
• Surgical Education
• Process Improvement

Background:

• Attending surgeons balance high-quality patient care with resident training.
• Lean principles are applied in healthcare, but operational variability data for surgeons is limited.
• Understanding surgical process variability is crucial for optimizing efficiency and training.

Purpose of the Study:

• To quantify variability and waste in retrosigmoid craniectomy (microvascular decompression [MVD] and internal neurolysis) and deep brain stimulation (DBS).
• To correlate operative variability with residents' self-reported readiness for surgical steps.
• To guide surgeons in balancing operative safety, efficiency, and training obligations.

Main Methods:

• Defined standard workflows for retrosigmoid craniectomy and DBS, segmenting operations into components.
• Observed and timed components of a representative sample of operations to measure variability.
• Administered surveys to assess surgeons' perceptions of safety and risk, correlating results with operative variability.

Main Results:

• Craniectomy showed highest mean duration and standard deviation for MVD; MVD itself had the lowest.
• Registration and electrode placement exhibited the largest duration variability for DBS.
• Increased resident training level correlated with a higher perception of safety in many surgical steps.

Conclusions:

• This study introduces a tool for process improvement in neurosurgery.
• The findings can aid surgeons in enhancing patient care efficiency.
• Optimizing operative workflows can support both surgical safety and effective resident training.