Time-Analysis Of Cataract Surgery Segments As A Tool To Evaluate Surgical Efficiency

Published 2023 - 41st Congress of the ESCRS

Reference: PP04.01 | DOI: 10.82333/qveh-wz15

Authors: Hadas Pizem ¹ , Ella Fainitsky ² , Modi Naftali* ¹ , Alexey Rapoport ¹ , Ori Scheyer ³ , Sergiu Socea ¹ , Eytan Blumenthal ¹

¹Ophthalmology,Rambam Health Care Campus,Haifa,Israel, ²The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology ,Haifa,Israel, ³Ophthalmology,Hillel Yaffe Medical Center,Hadera ,Israel

Utilizing time-analysis of cataract surgery segments to assess the efficiency and variations of cataract surgery.

Retrospective study.

Two hundred randomly selected videos of uneventful cataract surgeries of four experienced surgeons were manually split into eight pre-defined segments, and each segment was timed. The mean duration (± standard deviation) of each step was calculated for each segment and surgeon. Individual surgeons' variation in duration was quantified using the coefficient of variation (CV), which is the standard deviation/mean duration. The phacoemulsification technique used in each surgery was noted.

The average surgery duration was 15.08 (±5.70) minutes. The average segment duration ranged from 1.17 (±0.90) minutes for the IOL implantation step to 4.70 (±2.35) minutes for the phacoemulsification step. The most consistent step by CV was the capsulorhexis (CV=0.43; mean duration=1.23±0.53 minutes), and most variable one was hydrating the ports and injecting antibiotics (CV=0.89; mean duration=1.30±1.16 minutes). Unexpectedly, the fastest surgeon had the highest variability (total surgery duration=10.10±3.16 minutes; CV=0.31). Outliers for each segment were identified. The most common phaco technique was horizontal chop (110/200, 55%).

Surgical steps duration and the coefficient of variation vary considerably between surgeons. Less variation of the length of cataract surgery steps does not indicate better efficiency. Concise surgeon-specific statistics for each of eight segments, identification of outliers and comparison with other surgeons may illuminate improvement opportunities for the individual surgeon.