Implementation of high-intensity theatre (HIT) lists in breast reconstruction to reduce elective plastic surgery waiting times.

Abstract

The COVID-19 pandemic left surgical specialties with unprecedented backlogs, with plastic surgery experiencing a 96.9% increase in waiting-list times between January 2020 and December 2023. To address this, we implemented a high-intensity theatre (HIT) list programme, adapted from other surgical specialties. HIT lists were implemented over two five-day periods in July 2023 and March 2024. Forty-nine patients underwent surgery: 19 breast reconstructions (28 flaps: 23 deep inferior epigastric artery perforator and 5 profunda artery perforator), 46 secondary breast procedures and 4 miscellaneous operations. Mean microsurgical-case operative time was 279 min, with no significant difference between unilateral and bilateral cases, and an average 12.5-min turnaround time between the cases. There was 1 flap take-back (2%) for breast haematoma evacuation with no flap compromise. Operative throughput per list more than doubled, and theatre start times were consistently earlier. There was a statistically significant improvement in staff-reported satisfaction, and BREAST-Q patient-reported outcomes were comparable to that of patients treated on conventional operating lists. This is the first reported adaptation of the HIT list model for microsurgical breast reconstruction, demonstrating that it is safe, efficient and scalable. Our approach accommodated a heterogenous case mix and delivered a 1.5-fold increase in efficiency per operating list whilst maintaining excellent surgical outcomes and patient-reported satisfaction. Multidisciplinary collaboration and meticulous planning were vital to success. This experience serves as a blueprint worldwide, illustrating how HIT lists can effectively tackle post-pandemic surgical backlogs, streamline essential surgical interventions and deliver high-quality care at scale within the existing constrained healthcare infrastructure.