Zrinzo Ludvic, Akram Harith, Hyam Jonathan, Candelario-Mckeown Joseph, Rangnekar Ranjit, Nwanze Ashley, Xu San San, Foltynie Thomas, Limousin Patricia, Krüger Marie T
Unit of Functional Neurosurgery, Department of Neurosurgery, National Hospital of Neurology and Neurosurgery, London, UK.
General Management, Department of Neurosurgery, National Hospital of Neurology and Neurosurgery, London, UK.
Stereotact Funct Neurosurg. 2025;103(2):81-89. doi: 10.1159/000542110. Epub 2024 Nov 28.
Rising NHS waiting lists are a major problem following the COVID-19 pandemic. In our institution, surgical waiting time for elective functional neurosurgical procedures, such as deep brain stimulation (DBS) and radiofrequency ablation (RFA), reached >1.5 years by the end of 2022. During 2023, reduced operating room availability, intraoperative MRI (iMRI) suite closure for refurbishment, and ongoing strikes threatened to increase waiting times further.
Our previous surgical workflow for DBS and RFA procedures was examined. Several aspects were identified, and changes implemented to increase efficiency. Procedure numbers, waiting times, lead placement accuracy, and complication rates before and after these changes were compared.
Prior to 2023, an average of 0.8 new procedures were performed per surgical list. Introduction of a new workflow in 2023 allowed an average of 1.6 new procedures per surgical list (100% increase in productivity). In 2023, 95 DBS and 31 RFA procedures were performed on 79 surgical lists. This represents a 52% increase over "pre-pandemic" activity in 2019 (74 DBS, 9 RFA) on 102 available surgical lists. Mean (SD) targeting accuracy (0.8 [0.4] mm) was comparable to previous years (0.9[0.3] mm). In 2023, there were no infections requiring hardware removal and only one asymptomatic haemorrhage following an RFA procedure. The surgical waiting time was reduced from >1.5 years to <4 months by the end of 2023.
Changes in surgical workflow, with neurosurgeons working in parallel, maximise surgical efficiency and productivity, significantly increasing the number of DBS and RFA procedures without compromising accuracy and safety.
Rising NHS waiting lists are a major problem following the COVID-19 pandemic. In our institution, surgical waiting time for elective functional neurosurgical procedures, such as deep brain stimulation (DBS) and radiofrequency ablation (RFA), reached >1.5 years by the end of 2022. During 2023, reduced operating room availability, intraoperative MRI (iMRI) suite closure for refurbishment, and ongoing strikes threatened to increase waiting times further.
Our previous surgical workflow for DBS and RFA procedures was examined. Several aspects were identified, and changes implemented to increase efficiency. Procedure numbers, waiting times, lead placement accuracy, and complication rates before and after these changes were compared.
Prior to 2023, an average of 0.8 new procedures were performed per surgical list. Introduction of a new workflow in 2023 allowed an average of 1.6 new procedures per surgical list (100% increase in productivity). In 2023, 95 DBS and 31 RFA procedures were performed on 79 surgical lists. This represents a 52% increase over "pre-pandemic" activity in 2019 (74 DBS, 9 RFA) on 102 available surgical lists. Mean (SD) targeting accuracy (0.8 [0.4] mm) was comparable to previous years (0.9[0.3] mm). In 2023, there were no infections requiring hardware removal and only one asymptomatic haemorrhage following an RFA procedure. The surgical waiting time was reduced from >1.5 years to <4 months by the end of 2023.
Changes in surgical workflow, with neurosurgeons working in parallel, maximise surgical efficiency and productivity, significantly increasing the number of DBS and RFA procedures without compromising accuracy and safety.
英国国家医疗服务体系（NHS）候诊名单不断增加是新冠疫情后的一个主要问题。在我们机构，截至2022年底，诸如脑深部电刺激术（DBS）和射频消融术（RFA）等择期功能性神经外科手术的手术等待时间已超过1.5年。在2023年，手术室可用时间减少、术中磁共振成像（iMRI）套房关闭进行翻新以及持续的罢工有可能使等待时间进一步增加。
我们检查了之前DBS和RFA手术的工作流程。确定了几个方面，并进行了改进以提高效率。比较了这些改变前后的手术数量、等待时间、电极植入准确性和并发症发生率。
在2023年之前，每个手术清单平均进行0.8例新手术。2023年引入新的工作流程后，每个手术清单平均可进行1.6例新手术（生产率提高100%）。2023年，在79个手术清单上进行了95例DBS手术和31例RFA手术。这比2019年“疫情前”102个可用手术清单上的手术量（74例DBS手术、9例RFA手术）增加了52%。平均（标准差）靶点定位准确性（0.8[0.4]毫米）与前几年（0.9[0.3]毫米）相当。2023年，没有感染需要取出硬件，RFA手术后只有一例无症状出血。到2023年底，手术等待时间从超过1.5年缩短至不到4个月。
通过神经外科医生并行工作改变手术工作流程，可最大限度提高手术效率和生产率，在不影响准确性和安全性的情况下显著增加DBS和RFA手术的数量。
英国国家医疗服务体系（NHS）候诊名单不断增加是新冠疫情后的一个主要问题。在我们机构，截至2022年底，诸如脑深部电刺激术（DBS）和射频消融术（RFA）等择期功能性神经外科手术的手术等待时间已超过1.5年。在2023年，手术室可用时间减少、术中磁共振成像（iMRI）套房关闭进行翻新以及持续的罢工有可能使等待时间进一步增加。
我们检查了之前DBS和RFA手术的工作流程。确定了几个方面，并进行了改进以提高效率。比较了这些改变前后的手术数量、等待时间、电极植入准确性和并发症发生率。
在2023年之前，每个手术清单平均进行0.8例新手术。2023年引入新的工作流程后，每个手术清单平均可进行1.6例新手术（生产率提高100%）。2023年，在79个手术清单上进行了95例DBS手术和31例RFA手术。这比2019年“疫情前”102个可用手术清单上的手术量（74例DBS手术、9例RFA手术）增加了52%。平均（标准差）靶点定位准确性（0.8[0.4]毫米）与前几年（0.9[0.3]毫米）相当。2023年，没有感染需要取出硬件，RFA手术后只有一例无症状出血。到2023年底，手术等待时间从超过1.5年缩短至不到4个月。
通过神经外科医生并行工作改变手术工作流程，可最大限度提高手术效率和生产率，在不影响准确性和安全性的情况下显著增加DBS和RFA手术的数量。
