The impact of a preloaded intraocular lens delivery system on operating room efficiency in routine cataract surgery

Figures & data

Table 1 Study site overview

Site name	Minnedosa Health Centre (Canada)	Medipole Ophthalmology Center (France)	Jones Eye Clinic (US)
Facility type	Hospital	Hospital	Ambulatory Surgical Center
Number of ORs	1	2	2
Cataract schedule (d/wk)	1	1 or 2	2
Cataract volume	Low (~10 cases/d)	Moderate (~17 cases/d)	High (~25 cases/d)
Case mix	All routine, monofocal cataract cases	Predominantly routine cataract cases, 62% monofocal	Predominantly routine cataract cases, 92% monofocal

Abbreviations: ORs, operating rooms; d, day; wk, week.

Table 2 Reduction in total case time by site

	Canada (one OR)		France (two ORs)		US (two ORs)
	Diff (%)	P-value	Diff (%)	P-value	Diff (%)	P-value
Setup time (median)	−14.4	<0.001	−7.7	NS	−17.0	<0.001
Surgery time (median)	−7.8	<0.01	−8.7	NS	−3.7	<0.10
Teardown time (median)	−10.3	NS	−4.1	NS	−12.5	<0.01
Total case time (mean)	−12.0	<0.001	−6.2	<0.05	−9.4	<0.001
Total case time (SD)	+5.0	NS	−27.2	NS	−11.8	NS

Notes: A two-sample t-test was used for independent samples. P-values above 0.10 were deemed not significant.

Abbreviations: ORs, operating rooms; Diff, difference; NS, not significant; SD, standard deviation.

Table 3 Surgeon delays in sites with two-OR setups

	France			US
	Manual	Preloaded	Diff (%)	Manual	Preloaded	Diff (%)
Percentage of cases with surgeon delay	30	20	−33	27	11	−59
Mean duration of delay (minutes)	0.9	0.8	−13	1.1	0.3	−72

Abbreviations: OR, operating room; Diff, difference.

Table 4 Impact of preloaded lens system efficiencies over entire surgery day in a Canadian, one-OR cataract center

	Canada
Mean number of manual cases per surgery day	10.2 cases/d
Monofocal case mix during manual observation period	100%
Total cataract cases eligible for preloaded system	10.2 cases/d
Mean total case time savings per monofocal cataract case	3.3 minutes
Estimated total case time savings per surgery day	33.7 minutes
Mean time between start of OR setup and completion of OR teardown with preloaded system	27.2 minutes
Potential increase in cataract throughput without increasing surgeon and staff capacity	1.2 cases

Abbreviations: d, day; OR, operating room.

Table 5 Impact of preloaded lens system efficiencies over entire surgery day in France and US, two-OR cataract centers

	France	US
Mean number of manual cases per surgery day	17.4 cases/d	25.2 cases/d
Monofocal case mix during manual observation period	61(%)	92(%)
Total cataract cases eligible for preloaded system	10.6 cases/d	23.2 cases/d
Median total surgery time savings per monofocal cataract case	0.6 (minutes)	0.4 (minutes)
Estimated surgery time savings per surgery day	5.8 (minutes)	9.3 (minutes)
Median surgeon delay time savings per surgery day	1.2 (minutes)	6.3 (minutes)
Estimated total surgeon time savings per surgery day	7.0 (minutes)	15.5 (minutes)
Median total surgery time with preloaded system	5.8 (minutes)	10.4 (minutes)
Potential increase in cataract throughput without increasing surgeon and staff capacity	1.2 (number of cases)	1.5 (number of cases)

Abbreviations: OR, operating room; d, day.

Table 6 Estimated annual throughput from time efficiencies by site

	Canada (one OR)		France (two ORs)		US (two ORs)
Observation period	Manual	Preloaded	Manual	Preloaded	Manual	Preloaded
Surgery days/month	3.0	3.0	7.5	7.5	8.0	8.0
Mean cases/day	10.2	11.2	17.4	18.4	25.1	26.1
Total cases/month	31	34	131	138	201	209
Total cases/year	366	402	1,566	1,656	2,412	2,508
Additional annual throughput	+36 (+9.9%)		+90 (+5.7%)		+96 (+4.0%)

Abbreviation: ORs, operating rooms.