Disruption Driving Innovation: Optimising Efficiency in Functional Neurosurgery

Introduction: 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. Methods: 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. Results: 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. Conclusion: 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.