{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:46:36Z","timestamp":1786124796304,"version":"build-2736575974"},"reference-count":16,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","license":[{"start":{"date-parts":[[2019,4,18]],"date-time":"2019-04-18T00:00:00Z","timestamp":1555545600000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Operative Surg.","ONSURG"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Attending surgeons have dual obligations to deliver high-quality health care and train residents. In modern healthcare, lean principles are increasingly applied to processes preceding and following surgery. However, surgeons have limited data regarding variability and waste during any given operation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To measure variability and waste during the following key functional neurosurgery procedures: retrosigmoid craniectomy (microvascular decompression [MVD] and internal neurolysis) and deep brain stimulation (DBS). Additionally, we correlate variability with residents\u2019 self-reported readiness for the surgical steps. The aim is to guide surgeons as they balance operative safety and efficiency with training obligations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>For each operation (retrosigmoid craniectomy and DBS), a standard workflow, segmenting the operation into components, was defined. We observed a representative sample of operations, timing the components, with a focus on variability. To assess perceptions of safety and risk among surgeons of various training levels, a survey was administered. Survey results were correlated with operative variability, attempting to identify areas for increasing value without compromising trainee experience.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      A sampling of each operation (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u00a0=\u00a036) was observed during the study period. For MVD, craniectomy had the highest mean duration and standard deviation, whereas the MVD itself had the lowest mean duration and standard deviation. For DBS, the segments with largest standard deviation in duration were registration and electrode placement. For many steps of both procedures, there was a statistically significant relationship between increasing level of training and increasing perception of safety.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>This proof-of-concept study introduces an educational and process-improvement tool that can be used to aid surgeons in increasing the efficiency of patient care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ons\/opz048","type":"journal-article","created":{"date-parts":[[2019,4,17]],"date-time":"2019-04-17T21:52:58Z","timestamp":1555537978000},"page":"622-631","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Balancing Operative Efficiency and Surgical Education: A Functional Neurosurgery Model"],"prefix":"10.1227","volume":"17","author":[{"given":"Abigail J","family":"Rao","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of California-Los Angeles and VA Greater Los Angeles Healthcare System, Los Angeles, California"},{"name":"Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon"},{"name":"Norton Neuroscience Institute, Norton Healthcare, Louisville, Kentucky"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carli","family":"Bullis","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine G","family":"Holste","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zoe","family":"Teton","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kim J","family":"Burchiel","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed M","family":"Raslan","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2019,12]]},"reference":[{"issue":"3","key":"bib1-20240909","doi-asserted-by":"crossref","first-page":"700","DOI":"10.3171\/2014.5.JNS131996","article-title":"Value-based neurosurgery: measuring and reducing the cost of microvascular decompression surgery","volume":"121","author":"McLaughlin","year":"2014","journal-title":"J Neurosurg"},{"issue":"2","key":"bib2-20240909","doi-asserted-by":"crossref","first-page":"462","DOI":"10.3171\/2013.9.JNS13663","article-title":"Value-based neurosurgery: the example of microvascular decompression surgery","volume":"120","author":"McLaughlin","year":"2014","journal-title":"J Neurosurg"},{"issue":"7","key":"bib3-20240909","doi-asserted-by":"crossref","first-page":"3071","DOI":"10.1007\/s00464-015-4599-6","article-title":"Elimination of waste: creation of a successful lean colonoscopy program at an academic medical center","volume":"30","author":"Damle","year":"2015","journal-title":"Surg Endosc"},{"issue":"6","key":"bib4-20240909","doi-asserted-by":"crossref","first-page":"928","DOI":"10.1016\/j.jamcollsurg.2012.03.002","article-title":"Lean management in academic surgery","volume":"214","author":"Collar","year":"2012","journal-title":"J Am Coll 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