Every year, the United States spends close to 18% of its gross domestic product on health care-a value that far surpasses that of any other developed nation. 1 Surgical expenditure accounts for nearly one-third of this national spending. 1 This cost has been projected to increase in coming years, as demand for additional operating rooms and procedural facilities continues to grow.Improving perioperative productivity and efficiency in the operating room is one approach that may help to reduce unnecessary costs for the hospital and the patient. 1,2 Furthermore, beyond the concrete financial savings, improving operating room efficiency can also increase operating room throughput, improve patient safety, and lead to greater staff and patient satisfaction (Fig. 1).Historically, quality improvement (QI) or process improvement models such as the Plan-Do-Study-Act model, the Focus-Analyze-Develop-Execute (FADE) model, and the Team Strategies and Tools to Enhance Performance and Patient Safety model have been used to increase productivity and eliminate inefficiencies within health care. 3,4 Alternative QI methodologies that are Background: Improving perioperative efficiency helps reduce unnecessary surgical expenditure, increase operating room throughput, improve patient safety, and enhance staff and patient satisfaction. Lean Six Sigma (LSS) is a quality improvement model that has been successfully applied to eliminate inefficiencies in the business sector but has not yet been widely adopted in medicine. This study investigates the adaptation of LSS to improve operative efficiency for plastic surgery procedures. Methods: The authors followed the define, measure, analyze, improve, and control phases to implement LSS. The key outcome measures gathered were operative times, including the cut-to-close time, and the total time the patient spent in the operating room. Results:The study included a total of 181 patients who underwent immediate bilateral deep inferior epigastric perforator flap breast reconstruction between January of 2016 and December of 2019. The LSS interventions were associated with a decrease in total operative time from 636.36 minutes to 530.35 minutes, and a decrease in the time between incision to closure from 555.16 minutes to 458.85 minutes for a bilateral mastectomy with immediate deep inferior epigastric artery flap breast reconstruction. Conclusions: This study demonstrates that LSS is useful to improve perioperative efficiency during complex plastic surgery procedures. The workflow of the procedure was improved by determining the optimal spatial positioning and distinct roles for each surgeon and preparing surgeon-specific surgical trays. Two process maps were developed to visualize the positioning of the surgeons during each stage of the procedure and depict the parallel workflow that helped improve intraoperative efficiency.

Background: The growth of social media has transformed advertising within plastic surgery. Recent studies have characterized these developments, but objective analysis is needed. Methods: This is a cross-sectional analysis of online media use by American Society of Plastic Surgeons members who received board certification in 2000, 2005, 2010, 2015, or 2019. Online searches and StatShow revealed social media and website metrics. Metropolitan-based practices were determined using Department of Agriculture continuum codes. Descriptive and quantitative analyses were used to make inferences regarding study aims. Results: This study included 811 surgeons. A total of 58.6 percent had practice websites and 43.9 percent had professional Instagram accounts. Instagram use was widespread across subspecialties and there was no significant difference in the number of followers by subspecialty (p = 0.34). Year of certification had no significant effect on the number of followers (p = 0.12); however, recently certified and seasoned members had the fewest. The top 1 percent of surgeons had more followers than the remaining 99 percent combined. Those with metropolitan-based practices had significantly higher website traffic (p = 0.01) but no difference in the number of followers (p = 0.88). There was no evidence that the number of followers or posts per month correlated with website traffic (R2 = 0.004 and 0.036, respectively). Conclusions: The study demonstrates findings from a cross-sectional analysis of plastic surgeons from different training backgrounds, regions, and tenure. The use of Instagram in professional practice is widespread but there is no correlation between its use and increased website traffic.