Optimizing Efficiency in Lower Extremity Microsurgical Reconstruction Using Six Sigma: From Procedure to Process

Area of Science:

• Microsurgery
• Orthopedic Surgery
• Quality Improvement

Background:

• Lower extremity reconstruction is resource-intensive with declining reimbursement.
• The COVID-19 pandemic exacerbated healthcare delivery challenges.
• Strategies to improve efficiency in lower extremity reconstruction are less defined than in breast microsurgery.

Purpose of the Study:

• To evaluate the impact of a structured quality improvement (QI) initiative on efficiency and outcomes in lower extremity reconstruction.
• To identify strategies for sustaining microsurgical care in a strained healthcare environment.

Main Methods:

• A single-center QI initiative using a Six Sigma DMAIC framework was implemented.
• Interventions included standardized preoperative planning, parallel workflows, process optimization, and increased co-surgeon utilization.
• Outcomes were compared between a pre-intervention cohort and a post-intervention cohort (October 2021 - May 2023).

Main Results:

• Mean operative time decreased significantly from 8.23±2.29 hours to 3.98±1.77 hours (p<0.001).
• Co-surgeon utilization increased from 22.6% to 79.2% (p<0.001).
• Operative throughput increased, enabling 52 additional operations within the same block time post-intervention.

Conclusions:

• A structured QI initiative significantly reduced operative time for lower extremity reconstruction without increasing complications.
• Stakeholder engagement and workflow optimization enhance efficiency and resource utilization.
• These improvements support the sustainability of complex microsurgical care.