Immediate Reconstruction Swing Room Scheduling Reduces Wait Times to Surgery and Increases Breast Reconstruction Rates

Ann Surg Oncol. 2019 May;26(5):1276-1283. doi: 10.1245/s10434-019-07216-y. Epub 2019 Feb 12.


Background: Despite benefits in quality of life, patient satisfaction, overall healthcare costs, and number of surgeries, historically fewer than 30% of patients undergo immediate breast reconstruction following mastectomy for breast cancer. A paucity of qualified oncologic and plastic surgeons coupled with inefficient use of operating room (OR) resources presents challenges in offering immediate breast reconstruction in a timely manner. To address these challenges, an immediate reconstruction swing room (IRSW) program was developed.

Methods: IRSW scheduling leverages two concurrently running ORs, with the surgical oncologist and plastic surgeon moving between rooms to complete 2-4 combined mastectomy cases with immediate reconstruction, in addition to 1-2 independent cases, each operative day. The final year of traditional booking was compared with IRSW scheduling to assess wait times and reconstruction rates.

Results: Comparing the 2 years, fewer surgical breast cases were performed with IRSW scheduling (1250 vs. 1178), however the overall number of oncology cases increased from 735 (59%) to 857 (73%). The number of immediate reconstructions performed increased from 75 to 139 (p < 0.0001), which reflects a mean of 1.2 IR cases versus 2.9 combined cases in IRSW. Overall, this facilitated an increase in the rate of immediate reconstruction following therapeutic mastectomy from 35 to 49% (p = 0.0004) and decreased wait times from core biopsy to surgery from 70 to 52 days (p < 0.0001).

Conclusions: A multidisciplinary model with optimized scheduling has the potential to improve resource utilization and access to breast cancer care.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Breast Neoplasms / pathology
  • Breast Neoplasms / surgery*
  • Carcinoma, Ductal, Breast / pathology
  • Carcinoma, Ductal, Breast / surgery*
  • Carcinoma, Lobular / pathology
  • Carcinoma, Lobular / surgery*
  • Female
  • Follow-Up Studies
  • Humans
  • Mammaplasty / statistics & numerical data*
  • Mastectomy / methods*
  • Middle Aged
  • Neoplasm Invasiveness
  • Operating Rooms
  • Patient Care Planning / standards*
  • Prognosis
  • Prospective Studies
  • Quality of Life*
  • Retrospective Studies
  • Waiting Lists