Factors affecting cataract surgery operating time amongst trainees and consultants

Session Details

Session Title: Training & Surgical Practice

Session Date/Time: Tuesday 25/09/2018 | 16:00-18:00

Paper Time: 16:42

Venue: Room A2

First Author: : P.Nderitu UK

Co Author(s): :    P. Ursell                    

Abstract Details

Purpose:

Cataract surgery is the most frequently performed operation in the UK with around 390,000 cataract procedures performed in England alone in 2015 – 2016, an increase from just over 287,000 procedures in the 2005 - 2006 year. Defining factors that affect cataract surgery operating time is therefore important for planning theatre lists, optimising throughput, enhancing patient experiences, minimising costs and ensuring adequate training time. We explored and quantified numerous factors that affect cataract surgery operating time amongst junior and senior ophthalmic trainee surgeons and consultants and assessed the trends in operating time over the last 5 years.

Setting:

All patients who underwent primary phacoemulsification cataract surgery from 1st Jan 2011 until 31st Dec 2016 at Epsom and St Helier University NHS Trust were included. All primary cataract procedures were included whilst combined anterior/posterior segment procedures and surgeons with <50 cases were excluded.

Methods:

Anonymised data were collected on demographics, anaesthesia, operating time, surgeon grade, case complexity, pupil size, pupil expander/capsular tension ring use, posterior capsular rupture (PCR)/zonular rupture (ZR)/zonular dialysis (ZD), vitreous loss (VL) and automated anterior vitrectomy (AAV). Standard 2.0-2.2mm clear corneal/limbal incisions, phacoemulsification using the Stellaris (Bausch & Lomb, Inc.) or Alcon Constellation (Alcon, Inc.) systems with foldable/preloaded injected lenses were included; no femtosecond cases were included. Operating time was defined as time out of theatre minus surgery start time and included the WHO check, draping, cataract extraction and undraping hence all relevant surgical events were captured.

Results:

From 11,067 cases, 9,552 (86.3%) had a recorded operating time. Mean (SD) operating time (minutes) were: 19(10) consultants, 30(11) junior, 27(12) intermediate, 24(10) senior trainees, 31(11) fellows. Operating time was shorter for topical vs. sub-Tenon or general anaesthesia cases. Consultant operating time remained unchanged with increasing complexity, except for highly complex cases. Small pupils, pupil expanders/capsular tension rings, PCR/ZR/ZD, VL and AAV were associated with increased operating times. Iris hooks were associated with increased operating time compared to Malyugin rings (16 vs. 6 extra minutes, p<0.001). There was a 3-minute decrease in operating time over 5 years amongst consultants.

Conclusions:

This study is the largest and longest follow-up to date evaluating factors affecting operating time. It shows that cataract surgery operating time is significantly influenced by anaesthesia type, surgeon grade, high case complexity, pupil size, pupil expander use/type, capsular tension ring use and intraoperative complications (PCR/ZR/ZD/VL/AAV). However, although trainees surgeons take longer, even amongst the most junior trainees, the operating time is less than 30 minutes and reduces with experience. This study is also the first to show the trend of decreasing operating time in cataract surgery, likely as a result of ever increasing theatre efficiency and improved operating techniques.

Financial Disclosure:

-