Transition to a novel advanced integrated vitrectomy platform: comparison of the surgical impact of moving from the Accurus vitrectomy platform to the Constellation Vision System for microincisional vitrectomy surgery

Figures & data

Table 1 Overall efficiency review comparing the Accurus to the Constellation surgical platform

	Accurus platform	Constellation platform	P-value
MIVS cases	281	233	n/a
MIVS/phaco	141	158	n/a
Surgical patients (per day)	7.55	8.53	P < 0.04
MIVS surgical room time (per case, minutes)	56	52	P < 0.01
MIVS surgical case time (per case, minutes)	35	31	P < 0.004
MIVS/phaco surgical case time (per case, minutes)	43	37	P < 0.001

Notes: Statistically significant increase in number of cases per day (surgical patients), decrease in surgical room time, and decrease in surgical procedure time (surgical case time). Combined MIVS and phacoemulsification with IOL implantation showed greatest improvement in time reduction for Constellation compared with Accurus across the entire 2-year cohorts. Note sample size of 514 MIVS cases and 299 combined MIVS/phacoemulsification cases accrued over two 1-year windows.

Abbreviations: MIVS, microincisional vitrectomy surgery; IOL, intraocular lens; Phaco, phacoemulsification.

Table 2 Comparison of Accurus and Constellation surgical platforms by procedure time and room time (in minutes) for all cases performed with at least seven cases per day

Surgical volume: seven or more patients per day OR 5 and 6, at least seven patients/day, ±2 standard deviation from mean room and procedure time Minimum 15 minute procedure time
Equipment	OR num	N claims	N patients	N days	Claims per day	Patients per day	Calc room time (H:MM)				Calc procedure time (H:MM)
							Min	Median	Max	Mean	Min	Median	Max	Mean
Accurus	5	123	110	29	4.24	3.79	0:27	0:56	1:37	0:57	0:15	0:36	1:18	0:36
	6	126	120	29	4.34	4.14	0:30	0:56	1:40	0:58	0:15	0:31	1:14	0:36
	All	249	219	29	8.59	7.55	0:27	0:56	1:40	0:58	0:15	0:35	1:18	0:36
Constellation	5	87	84	19	4.58	4.42	0:28	0:48	1:17	0:51	0:15	0:30	0:57	0:31
	6	86	85	19	4.53	4.47	0:31	0:53	1:31	0:54	0:15	0:33	1:03	0:34
	All	173	162	19	9.11	8.53	0:28	0:52	1:31	0:52	0:15	0:31	1:03	0:32

Notes: Data presented include number of patients, patients per day, room time, and procedure time. Times are reported as minimum, median, maximum, and mean time for operating rooms 5 and 6 and as combined (all). The comparison by case number per day was to evaluate the impact of high surgical numbers per day on overall efficiency in the operating room.

Abbreviation: OR, operating room.

Table 3 Comparison of Accurus and Constellation surgical platforms by procedure time and room time (in minutes) for all cases performed regardless of number of cases per day

Surgical volume: all days OR 5 and 6, all days, ±2 standard deviations from mean room and procedure time Minimum 15 minute procedure time
Equipment	OR Num	N claims	N patients	N days	Claims per day	Patients per day	Calc room time (H:MM)				Calc procedure time (H:MM)
							Min	Median	Max	Mean	Min	Median	Max	Mean
Accurus	5	162	145	47	3.45	3.09	0:27	0:54	1:49	0:57	0:15	0:35	1:21	0:36
	6	163	154	47	3.47	3.28	0:30	0:58	1:47	0:59	0:15	0:35	1:19	0:37
	All	325	281	49	6.63	5.73	0:27	0:57	1:49	0:58	0:15	0:35	1:21	0:37
Constellation	5	130	121	39	3.33	3.10	0:28	0:52	1:27	0:52	0:15	0:31	1:12	0:33
	6	129	127	38	3.39	3.34	0:31	0:53	1:37	0:54	0:15	0:31	1:12	0:33
	All	259	233	39	6.64	5.97	0:28	0:53	1:37	0:53	0:15	0:31	1:12	0:33

Notes: Data presented include number of patients, patients per day, room time, and procedure time. Times are reported as minimum, median, maximum, and mean time for operating rooms 5 and 6 and as combined (all). The comparison by all case number per day was to evaluate the overall impact on efficiency in the operating room.

Abbreviation: OR, operating room.

Table 4 Comparison of Accurus and Constellation surgical platforms by procedure time and room time (in minutes) for all cases performed with at least four cases per day

Surgical volume: at least 4 patients per day OR room 5 and 6, at least 4 patients/day, ±2 std dev from mean room and procedure time Minimum 15 minute procedure time
Equipment	OR room num	N claims	N patients	N days	Claims per day	Patients per day	Calc room time (H:MM)				Calc procedure time (H:MM)
							Min	Median	Max	Mean	Min	Median	Max	Mean
Accurus	5	155	139	43	3.60	3.23	0:27	0:54	1:37	0:57	0:15	0:35	1:18	0:36
	6	157	149	42	3.74	3.55	0:30	0:58	1:40	0:59	0:15	0:35	1:14	0:36
	All	312	270	43	7.26	6.28	0:27	0:56	1:40	0:58	0:15	0:35	1:18	0:36
Constellation	5	133	123	36	3.69	3.42	0:28	0:53	1:56	0:55	0:15	0:31	1:26	0:35
	6	128	126	36	3.56	3.50	0:31	0:54	1:49	0:56	0:15	0:33	1:28	0:35
	All	261	236	36	7.25	6.56	0:28	0:53	1:56	0:55	0:15	0:32	1:28	0:35

Notes: Data presented include number of patients, patients per day, room time, and procedure time. Times are reported as minimum, median, maximum, and mean time for operating rooms 5 and 6 and as combined (all). The comparison by case number per day was to evaluate the impact of lower surgical numbers per day on overall efficiency in the operating room.

Abbreviation: OR, operating room.

Table 5 Comparison of Accurus and Constellation surgical platforms by procedure time and room time (in minutes) for all cases

Accurus versus Constellation Vision System: room time and procedure time (minutes) t-test procedure
Variable	Equipment	N	Lower CL mean	Mean	Upper CL mean	Lower CL Std dev	Std dev	Upper CL Std dev	Std err	Min	Max
Statistics
Procedure time minutes	Accurus	249	34.148	35.916	37.683	13.019	14.163	15.53	0.8976	15	78
Procedure time minutes	Constellation	173	30.727	32.422	34.117	10.216	11.294	12.628	0.8586	15	63
Procedure time minutes	Diff (1–2)		0.952	3.4937	6.0354	12.238	13.064	14.012	1.2931
Room time minutes	Accurus	249	55.664	57.783	59.902	15.604	16.975	18.613	1.0758	27	100
Room time minutes	Constellation	173	50.371	52.341	54.311	11.873	13.126	14.676	0.9979	28	91
Room time minutes	Diff (1–2)		2.4237	5.4421	8.4605	14.533	15.515	16.64	1.5356
Variable	Method	Variances	DF	t-value	Pr > |t|
t-tests
Procedure time minutes	Pooled	Equal	420	2.70	0.0072
Procedure time minutes	Satterthwaite	Unequal	412	2.81	0.0051
Room time minutes	Pooled	Equal	420	3.54	0.0004
Room time minutes	Satterthwaite	Unequal	415	3.71	0.0002
Variable	Method	Num DF	Den DF	F value	Pr > F
Equality of variances
Procedure time minutes	Folded F	248	172	1.57	0.0016
Room time minutes	Folded F	248	172	1.67	0.0003

Notes: Statistical evaluation using Student’s t-test with evaluation of equality of variance. Note Constellation procedure and room times both show a statistically significant reduction with an average reduction of approximately 5 minutes (P < 0.007 and P < 0.0004) per procedure and per case.

Abbreviations: CL, confidence level; std dev, standard deviation; std err, standard error; Pr, probability.

Table 6 Comparison of Accurus and Constellation surgical platforms for combined microincisional vitrectomy surgery with phacoemulsification and IOL implantation for all cases performed with at least seven cases per day

Murray combined surgery: subset of at least 7 patients per day Murray combined surgery summary Anterior: 66820–66986 Posterior: 67015–67113, not 67028 and 67107 OR room 5 and 6, at least 7 patients/day, ±2 std dev from mean room and procedure time Minimum 15 minute procedure time
Equipment	OR room num	N claims	N patients	N days	Claims per day	Patients per day	Calc room time (H:MM)				Calc procedure time (H:MM)
							Min	Median	Max	Mean	Min	Median	Max	Mean
Accurus	5	60	59	29	2.07	2.03	0:47	1:06	1:32	1:06	0:24	0:42	1:01	0:43
	6	52	51	28	1.86	1.82	0:37	1:09	1:40	1:09	0:26	0:43	1:14	0:44
	All	112	108	29	3.86	3.72	0:37	1:07	1:40	1:07	0:24	0:43	1:14	0:43
Constellation	5	57	56	18	3.17	3.11	0:36	0:56	1:17	0:56	0:23	0:35	0:57	0:36
	6	62	62	19	3.26	3.26	0:37	0:56	1:31	0:58	0:20	0:38	1:00	0:37
	All	119	114	19	6.26	6.00	0:36	0:56	1:31	0:57	0:20	0:35	1:00	0:37

Notes: Data presented include number of patients, patients per day, room time, and procedure time. Times are reported as minimum, median, maximum, and mean time for operating rooms 5 and 6 and as combined (all). The comparison by case number per day was to evaluate the impact of higher surgical numbers per day on overall efficiency in the operating room.

Abbreviations: OR, Operating room; IOL, intraocular lens.

Table 7 Comparison of Accurus and Constellation surgical platforms for combined microincisional vitrectomy surgery with phacoemulsification and IOL implantation for all cases performed

Combined surgery summary: all days OR room 5 and 6, all patients/day, ±2 std dev from mean room and procedure time Minimum 15 minute procedure time
Equipment	OR room num	N claims	N patients	N days	Claims per day	Patients per day	Calc room time (H:MM)				Calc procedure time (H:MM)
							Min	Median	Max	Mean	Min	Median	Max	Mean
Accurus	5	74	73	40	1.85	1.83	0:46	1:06	1:49	1:06	0:24	0:42	1:15	0:43
	6	71	70	40	1.78	1.75	0:37	1:09	1:40	1:09	0:26	0:45	1:14	0:45
	All	145	141	44	3.30	3.20	0:37	1:07	1:49	1:07	0:24	0:44	1:15	0:44
Constellation	5	80	78	34	2.35	2.29	0:36	0:58	1:23	0:58	0:20	0:35	1:02	0:37
	6	86	86	34	2.53	2.53	0:37	0:56	1:32	0:58	0:20	0:36	1:00	0:37
	All	166	158	37	4.49	4.27	0:36	0:57	1:32	0:58	0:20	0:35	1:02	0:37

Notes: Data presented include number of patients, patients per day, room time, and procedure time. Times are reported as minimum, median, maximum, and mean time for operating rooms 5 and 6 and as combined (all). The comparison by all cases per day was to eliminate selection bias on evaluation of operating room efficiency.

Abbreviations: OR, Operating room; IOL, intraocular lens.

Table 8 Comparison of Accurus and Constellation surgical platforms for combined microincisional vitrectomy surgery with phacoemulsification and IOL implantation for all cases performed with at least four cases per day

Combined surgery summary: at least 4 patients per day OR room 5 and 6, at least 4 patients/day, ±2 std dev from mean room and procedure time Minimum 15 minute procedure time
Equipment	OR room num	N claims	N patients	N days	Claims per day	Patients per day	Calc room time (H:MM)				Calc procedure time (H:MM)
							Min	Median	Max	Mean	Min	Median	Max	Mean
Accurus	5	71	70	38	1.87	1.84	0:46	1:06	1:32	1:05	0:24	0:42	1:01	0:43
	6	69	68	38	1.82	1.79	0:37	1:09	1:40	1:08	0:26	0:45	1:14	0:45
	All	140	136	41	3.41	3.32	0:37	1:07	1:40	1:07	0:24	0:44	1:14	0:44
Constellation	5	80	78	34	2.35	2.29	0:36	0:58	1:56	0:58	0:20	0:35	1:19	0:37
	6	86	86	34	2.53	2.53	0:37	0:56	1:45	0:59	0:20	0:36	1:00	0:37
	All	166	157	36	4.61	4.36	0:36	0:57	1:56	0:58	0:20	0:35	1:19	0:37

Notes: Data presented include number of patients, patients per day, room time, and procedure time. Times are reported as minimum, median, maximum, and mean time for operating rooms 5 and 6 and as combined (all). The comparison by case number per day was to evaluate the impact of lower surgical numbers per day on overall efficiency in the operating room.

Abbreviations: OR, Operating room; IOL, intraocular lens.

Table 9 Comparison of Accurus and Constellation surgical platforms by procedure time and room time (in minutes) for combined microincisional vitrectomy and phacoemulsification with IOL implantation

Accurus versus Constellation Vision System Combined MIVS and phacoemulsification Procedure time and room time (minutes) t-test procedure
Variable	Equipment	N	Lower CL Mean	Mean	Upper CL Mean	Lower CL std dev	Std dev	Upper CL std dev	Std err	Min	Max
Statistics
Procedure time minutes	Accurus	112	41.471	43.339	45.208	8.8203	9.978	11.488	0.9428	24	74
Procedure time minutes	Constellation	119	35.041	36.773	38.505	8.4632	9.5407	10.935	0.8746	20	60
Procedure time minutes	Diff (1–2)		4.0357	6.5662	9.0967	8.9376	9.7551	10.738	1.2843
Room time minutes	Accurus	112	64.746	67.205	69.665	11.611	13.135	15.123	1.2411	37	100
Room time minutes	Constellation	119	55.09	57.126	59.162	9.9497	11.216	12.855	1.0282	36	91
Room time minutes	Diff (1–2)		6.9187	10.079	13.24	11.163	12.184	13.412	1.604
Variable	Method	Variances	DF	t-value	Pr > |t|
t-test
Procedure time minutes	Pooled	Equal	229	5.11	<0.0001
Procedure time minutes	Satterthwaite	Unequal	226	5.11	<0.0001
Room time minutes	Pooled	Equal	229	6.28	<0.0001
Room time minutes	Satterthwaite	Unequal	219	6.25	<0.0001
Variable	Method	Num DF	Den DF	F-value	Pr > F
Equality of variances
Procedure time minutes	Folded F	111	118	1.09	0.6310
Room time minutes	Folded F	111	118	1.37	0.0917

Notes: Statistical evaluation using Student’s t-test with evaluation of equality of variance. Note Constellation procedure and room times both show a statistically significant reduction with an average reduction of approximately 7 minutes (P < 0.0001) and 10 minutes (P < 0.0001) per procedure and per case.

Abbreviations: IOL, intraocular lens; MIVS, microincisional vitrectomy surgery; CL, confidence level; std dev, standard deviation; std err, standard error.