A systematic review of intraoperative process mapping in surgery

Chung, Ru Dee; Hunter-Smith, David J.; Spychal, Robert; Ramakrishnan, Venkat; Rozen, Warren M.

doi:10.21037/gs.2017.11.02

Cited by 13 publications

(11 citation statements)

References 31 publications

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“…The intraoperative surgical process is undoubtedly influenced by equipment and implant materials, age, patient comorbidities, individual surgeon skill, and case complexity. 33 For example, if extensive amounts of bone endplates have been excessively removed during endplate preparation for LLIF, then it is likely that even grafts with low modulus values will subside into the damaged endplate. 16 Additionally, bone density, cage shape, age, and applied distraction may result in increased subsidence rates as well.…”

Section: Discussionmentioning

confidence: 99%

PEEK versus titanium cages in lateral lumbar interbody fusion: a comparative analysis of subsidence

Campbell¹,

Cavanaugh²,

Nunley³

et al. 2020

Neurosurgical Focus

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OBJECTIVEThe authors have provided a review of radiographic subsidence after lateral lumbar interbody fusion (LLIF) as a comparative analysis between titanium and polyetheretherketone (PEEK) cages. Many authors describe a reluctance to use titanium cages in spinal fusion secondary to subsidence concerns due to the increased modulus of elasticity of metal cages. The authors intend for this report to provide observational data regarding the juxtaposition of these two materials in the LLIF domain.METHODSA retrospective review of a prospectively maintained database identified 113 consecutive patients undergoing lateral fusion for degenerative indications from January to December 2017. The surgeons performing the cage implantations were two orthopedic spine surgeons and two neurosurgeons. Plain standing radiographs were obtained at 1–2 weeks, 8–12 weeks, and 12 months postoperatively. Using a validated grading system, interbody subsidence into the endplates was graded at these time points on a scale of 0 to III. The primary outcome measure was subsidence between the two groups. Secondary outcomes were analyzed as well.RESULTSOf the 113 patients in the sample, groups receiving PEEK and titanium implants were closely matched at 57 and 56 patients, respectively. Cumulatively, 156 cages were inserted and recombinant human bone morphogenetic protein–2 (rhBMP-2) was used in 38.1%. The average patient age was 60.4 years and average follow-up was 75.1 weeks. Subsidence in the titanium group in this study was less common than in the PEEK cage group. At early follow-up, groups had similar subsidence outcomes. Statistical significance was reached at the 8- to 12-week and 52-week follow-ups, demonstrating more subsidence in the PEEK cage group than the titanium cage group. rhBMP-2 usage was also highly correlated with higher subsidence rates at all 3 follow-up time points. Age was correlated with higher subsidence rates in univariate and multivariate analysis.CONCLUSIONSTitanium cages were associated with lower subsidence rates than PEEK cages in this investigation. Usage of rhBMP-2 was also robustly associated with higher endplate subsidence. Each additional year of age correlated with an increased subsidence risk. Subsidence in LLIF is likely a response to a myriad of factors that include but are certainly not limited to cage material. Hence, the avoidance of titanium interbody implants secondary solely to concerns over a modulus of elasticity likely overlooks other variables of equal or greater importance.

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Section: Discussionmentioning

confidence: 99%

PEEK versus titanium cages in lateral lumbar interbody fusion: a comparative analysis of subsidence

Campbell¹,

Cavanaugh²,

Nunley³

et al. 2020

Neurosurgical Focus

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“…Although only a few studies have employed the use of process mapping [ 8 , 11 ], including maternal health studies, their findings have revealed that the application of insights from process mapping helps to remarkably improve healthcare quality. Process mapping in general, is a potentially useful exercise but its use has been underutilized ..…”

Section: Introductionmentioning

confidence: 99%

Assessing the functionality of an emergency obstetric referral system and continuum of care among public healthcare facilities in a low resource setting: an application of process mapping approach

Ofosu

Ofori

Ntumy

et al. 2021

BMC Health Serv Res

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Background Weak referral systems remain a major concern influencing timely access to the appropriate level of care during obstetric emergencies, particularly for Low-and Middle-Income Countries, including Ghana. It is a serious factor threatening the achievement of the maternal health Sustainable Development Goal. The objective of this study is to establish process details of emergency obstetric referral systems across different levels of public healthcare facilities to deepen understanding of systemic barriers and preliminary solutions in an urban district, using Ablekuma in Accra, Ghana as a case study. Methods The study is an analytical cross-sectional study. Nine [1] targeted interviews were carried out for a three-week period in June and July 2019 after informed written consent with two [2] Obstetrics & Gynaecology consultants, two [2] Residents, one family physician, and four [3] Midwives managing emergency obstetric referral across different levels of facilities. Purposeful sampling technique was used to collect data that included a narration of the referral process, and challenges experienced with each step. Qualitative data was transcribed, coded by topics and thematically analysed. Transcribed narratives were used to draft a process map and analyze the defects within the emergency obstetric referral system. Results Out of the 34 main activities in the referral process within the facilities, the study identified that 24 (70%) had a range of barriers in relation to communication, transport system, resources (space, equipment and physical structures), staffing (numbers and attitude), Healthcare providers (HCP) knowledge and compliance to referral policy and guideline, and financing for referral. These findings have implication on delay in accessing care. HCP suggested that strengthening communication and coordination, reviewing referral policy, training of all stakeholders and provision of essential resources would be beneficial. Conclusion Our findings clearly establish that the emergency obstetric referral system between a typical teaching hospital in an urban district of Accra-Ghana and peripheral referral facilities, is functioning far below optimum levels. This suggests that the formulation and implementation of policies should be focused around structural and process improvement interventions, strengthening collaborations, communication and transport along the referral pathway. These suggestions are likely to ensure that women receive timely and quality care.

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“…Finally, the literature analysis reveals that most studies mention few real examples or provide information about the implementation process of lean projects that could help future studies to streamline the use of the lean methodology to the health sector (Bonome et al, 2016). In the article by Chung et al (2017), a systematic review of projects is carried out in the intrasurgical field, where process mapping was used to identify steps that could be modified to improve the results, and a series of interventions was implemented for this purpose.…”

Section: Literature Reviewmentioning

confidence: 99%

Value-based lean implementation in a surgical unit: the impact of the methodology

Sales

Vila

2021

TQM

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PurposeThis paper aims to present a method for strategic planning and implementation processes in health care based on lean management.Design/methodology/approachWithin the framework of the action research methodology, the authors present the ten steps of a kaizen project, which enable lean transformation over a period of time. The study is underpinned by a literature review of enablers and barriers and an implementation case in a tertiary care hospital.FindingsKey points and possible contingency issues are presented for each of the steps, and a successful lean tools intervention is illustrated by examples of improvement projects of the surgical process. Conclusions of the implementation establish a roadmap for improvement projects in hospital environments based on lean management, thus bridging the existing gap between the large number of theoretical projects (much of the projects described are not sustainable over time as the hospital sector is very particular) that have failed to be implemented, or been paused mid-term, and the self-sustaining projects developed by improvement teams in the hospital.Originality/valueThe study details knowledge gleaned from a three-year project entailing various stages: forming improvement teams; training health-care professionals in lean management; drawing up a process map to identify value stream mapping improvement opportunities; implanting projects and verifying the results obtained; and finally, laying the cornerstones, which would make the project self-sustaining and open to long-term continuous improvement.

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A systematic review of intraoperative process mapping in surgery

Cited by 13 publications

References 31 publications

PEEK versus titanium cages in lateral lumbar interbody fusion: a comparative analysis of subsidence

PEEK versus titanium cages in lateral lumbar interbody fusion: a comparative analysis of subsidence

Assessing the functionality of an emergency obstetric referral system and continuum of care among public healthcare facilities in a low resource setting: an application of process mapping approach

Value-based lean implementation in a surgical unit: the impact of the methodology

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