The Division of Plastic and Reconstructive Surgery has been hard at work advancing its quality metrics as it focuses on improving patient experiences and outcomes for the services it provides, from cranioplasty to breast reconstruction surgery.
“There are many factors to examine when looking at outcomes,” said Kaylan Dadireddy, M.D., MCh, an assistant professor in the division who stepped into the role of director of patient quality and safety in February and has since been busy looking at ways to enhance patient outcomes across the perioperative spectrum by combining a keen eye for data with multidisciplinary collaboration. “We look at a number of quality metrics including length of stay, readmission after surgery and postoperative complications. The goal is not only to recognize patterns in the data but to also sit down with providers and determine what these patterns mean and how to use the numbers to improve practice.”
One challenge specific to Dadireddy’s division is that his team is often called in toward the end of complex procedures such as cranioplasty, where the skull is repaired after brain surgery.
When patients require multiple cranial procedures, Dadireddy said, it can become more and more difficult to properly close the incision area since the skin begins to grow tight. This can lead to postoperative complications.
“I talked to the neurosurgical team and suggested we collaborate,” he said. “Send patients to my clinic and let me assess whether they can be helped by expanding the skin around the area prior to surgery and give them the best chance of avoiding complications and the need for readmission.”
Expanding the skin around incision areas is only one of many strategies surgeons in Dadireddy’s division leverage, and collaborating with neurosurgery in the preoperative period allows the plastics team to choose which of these strategies will be most effective for each patient.
“Cranioplasties represent an often overlooked but critical part of neurosurgical care,” said Matthew Koch, M.D., an assistant professor in the Lillian S. Wells Department of Neurosurgery. “These are cases with a profound impact on patients’ lives; achieving optimal wound care and healing is essential to patient outcomes. Combining the dual focus of neurosurgical and plastic surgical care optimizes this care.”
Bruce Mast, M.D., FACS, chief of plastic surgery and the Maurice J. Jurkiewicz Professor of Surgery, has also been implementing changes designed to reduce infection after breast reconstruction surgery.
Breast reconstruction is often done with breast implants. In preparation for these procedures, tissue expanders are implanted during mastectomies and remain in the body for several months. Mast and his team take care to ensure that these types of implant-based procedures, similar to the cranial work done in Dadireddy’s clinic, do not lead to postoperative complications for patients.
Mast has been looking at the potential for antibiotic-eluding polymethylmethacrylate cement, often used by orthopedists when dealing with fractures, to reduce complications in his patients.
“We’re making a flat disc about 6 to 8 centimeters long, which is placed between the pectoral muscle and the tissue expander,” Mast said. “The cement elutes antibiotics for about six weeks, and so we’re hoping the use of this disc will significantly reduce infection by releasing a low dose of medication for a longer period of time, while the area is vulnerable to infection.”
Mast said infection is a condition he and his team are constantly looking to address because treating infections can delay a patient’s reconstruction, as well as other cancer treatments such as chemotherapy or radiation therapy.
“We’re always looking for ways to reduce infection as much as possible, and we’re excited by the potential of reducing infection rates by using new methods of implant-based reconstruction,” he said.
Mast and Dadireddy both look forward to analyzing the data produced by these quality projects, which they hope will lead to further opportunities to improve patient experiences and outcomes.