Application of Lean Methodologies in Plastic Surgery: A Systematic Review.

Background: We systematically reviewed whether lean management (LM) has improved efficiency and reduced waste in plastic surgery departments. LM is a set of principles first developed by Toyota in the 1950s to optimize efficiency and reduce waste in production systems. Methods: Four databases were searched from January 2008 to October 2023 to select studies using LM in plastic surgery departments. We included prospective, retrospective, and comparative studies in English. Given the heterogeneity of outcomes, we used the measures of effect as reported in the studies to compare findings. Results: A total of 2037 articles were identified, of which 19 met the inclusion criteria, comprising 3208 patients overall, with an average study length of 24 months. Most of the studies were prospective (n = 15, 79%) and conducted in the United States (n = 12, 63%). All studies showed improvement in their outcomes, including reduced time spent in theater (n = 6, 32%), cost savings (n = 5, 26%), reduced hospital length of stay (n = 5, 26%), and patient and staff satisfaction (n = 4, 21%). Morbidity and mortality remained unchanged in a majority of studies (n = 4, 21%). Conclusions: The need to improve our sustainability and patient flow is essential given worsening service pressures. LM provides an effective framework to optimize the efficiency of service provision and improve patient and staff satisfaction in plastic surgery departments. Larger studies are needed to understand the impact of greater efficiency on patient morbidity and mortality.