Pellini Francesca, Di Filippo Giacomo, Mirandola Sara, Deguidi Giulia, Filippi Elisa, Pollini Giovanni Paolo
Complex Operative Unit of Breast Surgery, Breast Unit, Oncologic Surgery Department, AOUI, Ospedale Civile Maggiore, Verona, Italy.
Front Surg. 2021 Mar 11;8:582980. doi: 10.3389/fsurg.2021.582980. eCollection 2021.
The advent of the COVID-19 pandemic has led to the sudden disruption of routine medical care, and the subsequent reorganization of hospital structures and therapeutic algorithms, aiming at protecting patients and health professionals. This was inevitably bound to affect our Breast Unit, dilating both pre- and post-operative times. The aim of this study was to evaluate the effect on patients' flow of organizational and logistic changes () based on lean thinking implemented after the COVID-19 outbreak. Clinical and demographic data were retrospectively collected from patients undergoing sentinel lymph node biopsy for breast cancer at the Verona University Hospital from January 2018 to June 2020. Patients enrolled ( = 341) were divided into two groups according to date of admission: before (Group A; = 294) and after (Group B; = 47) the implementation of key interventions. Each case in Group B was subsequently matched 1:1 by means of case-control matching with cases from Group A for age, comorbidities, and type of surgery (Subgroup A1; = 47). Pre-admission time (T0) and length of stay (T1) were compared between the three groups. Median T0 was 312 h, whereas median T1 was 24 h. Patients in Group B had a higher frequency of comorbidities (57.4 vs. 25.2%, = 0.001) and underwent mastectomy more often than patients in Group A (61.7 vs. 36.7%, = 0.001). Both median T0 and T1 were higher in group B than in group A (384 vs. 300 h, = 0.001, 48 vs. 24 h, = 0.001, respectively). Median T0 and T1 did not significantly differ between Group B and Subgroup A1 (all > 0.05). Lean thinking and new technologies could prove useful to the optimization of preoperative and postoperative times during the current pandemic, minimizing healthcare personnel and patients' exposure to SARS-CoV-2, and promoting a rational use of limited resources, while complying with oncological principles.
新冠疫情的出现导致常规医疗护理突然中断，随后医院结构和治疗算法进行了重组，旨在保护患者和医护人员。这不可避免地会影响我们的乳腺科，延长术前和术后时间。本研究的目的是评估基于新冠疫情爆发后实施的精益思维所带来的组织和后勤变化对患者流程的影响。回顾性收集了2018年1月至2020年6月在维罗纳大学医院接受乳腺癌前哨淋巴结活检患者的临床和人口统计学数据。根据入院日期将纳入的患者（n = 341）分为两组：关键干预措施实施前（A组；n = 294）和实施后（B组；n = 47）。随后，通过病例对照匹配，按照年龄、合并症和手术类型将B组的每个病例与A组的病例进行1:1匹配（A1亚组；n = 47）。比较了三组的入院前时间（T0）和住院时间（T1）。T0的中位数为312小时，而T1的中位数为24小时。B组患者的合并症发生率更高（57.4%对25.2%，P = 0.001），与A组患者相比，接受乳房切除术的频率更高（61.7%对36.7%，P = 0.001）。B组的T0和T1中位数均高于A组（分别为384对300小时，P = 0.001；48对24小时，P = 0.001）。B组和A1亚组之间的T0和T1中位数无显著差异（所有P > 0.05）。在当前疫情期间，精益思维和新技术可能有助于优化术前和术后时间，最大限度减少医护人员和患者接触SARS-CoV-2的机会，并促进有限资源的合理利用，同时遵循肿瘤学原则。
