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Updated: Jul 16, 2026

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Targeted Multidisciplinary Continuous Improvement Process Reduces Time to Breast Cancer Surgery with Immediate

Pooja M Varman1, Rahul Rangan2, Amanda Maggiotto3

  • 1Department of General Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA. varmanp@ccf.org.

Annals of Surgical Oncology
|July 14, 2026
PubMed
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A quality improvement initiative significantly reduced time to treatment for breast cancer patients undergoing immediate breast reconstruction. Operating room alignment was key to improving care coordination and reducing delays.

Area of Science:

  • Oncology
  • Surgical Oncology
  • Quality Improvement Science

Background:

  • Immediate breast reconstruction (IBR) often leads to delays in adjuvant therapy for breast cancer patients.
  • Upfront surgery with IBR necessitates efficient treatment pathways.

Purpose of the Study:

  • To evaluate a multiphase quality improvement (QI) initiative aimed at reducing time to treatment (TTT) for breast cancer patients undergoing upfront surgery with IBR.
  • To assess the impact of the QI initiative on TTT for both IBR and non-IBR patients.

Main Methods:

  • Retrospective cohort study of 3,324 breast cancer patients (January 2022 - June 2025).
  • QI initiative included multidisciplinary team huddles, standardized communication, and operating room (OR) alignment between breast and plastic surgery.

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  • Primary outcome: median TTT; balancing metric: TTT for non-IBR patients.

    • Main Results:

    • Median TTT decreased from 56 to 36 days for IBR patients (P < 0.001) and 41 to 29 days for non-IBR patients (P < 0.001).
    • Proportion of patients waiting >45 days reduced from 67.4% to 27.3% (IBR) and 40.5% to 22.9% (non-IBR).
    • OR alignment (Phase 3) significantly improved TTT for the IBR group, while the non-IBR group plateaued after Phase 2.

    Conclusions:

    • A targeted multidisciplinary QI initiative effectively reduced TTT for breast cancer patients undergoing upfront surgery with IBR.
    • Operating room alignment proved to be the critical intervention for improving system-level coordination between surgical teams.
    • The QI initiative successfully reduced treatment delays without negatively impacting non-IBR patients.