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Enhancing Margin Precision: A Work System Approach to Lumpectomies and Mastectomies

DescriptionReoperation rates in breast cancer surgeries, such as lumpectomies and mastectomies, currently range between 20% and 40%, despite the use of intraoperative margin assessment techniques like frozen section analysis. Though general obstacles to surgeries exist, little is known regarding the specific occurrence and nature of challenges related to margin definition and assessment in breast cancer surgeries. In this study, we applied the Systems Engineering Initiative for Patient Safety (SEIPS) model to systematically analyze and identify factors influencing margin assessment effectiveness. We conducted direct observations of nine surgeries by four surgeons at a quaternary medical center, which were analyzed using SEIPS-based process analysis and a barrier and facilitator analysis. We identified 17 high level steps encompassing the surgical procedure from process analysis. The barrier and facilitator analysis uncovered 38 barriers and 62 facilitators impacting intraoperative margin definition and assessment, which we inductively categorized into dimensions, including teamwork, information display design, tissue characteristics and intraoperative tool use. Our findings indicate teamwork to be particularly prevalent, followed by information display design and intraoperative tool use. This study provides insights to support the design of workflow-adaptive solutions, contributing to the improvement of margin accuracy and surgical performance in breast oncology procedures.

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