If you think of it, use it: the true cost saving from preventing complications during cataract surgery

Session Details

Session Title: Training & Surgical Practice

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

Paper Time: 17:12

Venue: Room A2

First Author: : A.Jamison UK

Co Author(s): :    L. Benjamin   D. Lockington                 

Abstract Details

Purpose:

Surgical adjuncts in cataract surgery are often perceived to be sometimes necessary, but always expensive, particularly in the modern cost saving era of “lean” surgical practices. However, prevention of a surgical complication, rather than subsequent management, should always be the preferred strategy. We wished to model the direct medical costs associated with addressing a moderately-dilated pupil cataract scenario and test the training maxim for surgical adjuncts - “if you think of it, use it”. We compared the cost of preventing a complication versus the subsequent management of vitreous loss (VL).

Setting:

Tennent Institute of Ophthalmology, Glasgow, Scotland.

Methods:

Two hypothetical approaches to the same patient (cortical cataract with a moderately-dilated pupil) undergoing cataract surgery were considered. The “minimalist” approach, in which no surgical adjuncts were used, resulted in posterior capsular rupture (PCR) with VL. The “cautious” approach, by utilising appropriate surgical adjuncts, avoided complications. The direct medical costs associated with each scenario, and their subsequent management, were compared. Cited costs were based on those locally reported within NHS Greater Glasgow & Clyde in February 2018 (Pound sterling, £).

Results:

The original surgery costs for the “cautious” approach scenario B was £835.88. Additional costs due to further follow up and intervention to address the impact of the complication in the “minimalist” approach scenario A were £1133.26. The Anterior Vitrectomy Kit, used in Scenario A, cost £116.83. Total overall cost of the “cautious” approach (£835.88) was 56.7% less than that of the “minimalist” approach with the complication (£1927.32). An additional initial spend on surgical adjuncts of £104.05 prevented £1195.49 in direct medical costs due to surgical complications.

Conclusions:

Through basic modeling of two clinical management scenarios, we have demonstrated the cost differences of prevention versus having to deal with the common complication of PCR/VL. This highlights the potential financial benefits provided by the use of precautionary surgical adjuncts during cataract surgery. This reinforces the cataract surgeon’s maxim – “if you think of it, use it”.

Financial Disclosure:

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