Factors affecting cataract surgery operating time among trainees and consultants.

ABSTRACT

PURPOSE: To define factors affecting cataract surgery operating time for operating room planning, optimizing throughput, enhancing patient experiences, minimizing costs, and allocating training time. SETTING: Epsom and St. Helier University National Health Service Trust, London, United Kingdom. DESIGN: Retrospective case series. METHODS: All patients who had primary manual phacoemulsification cataract surgery from January 1, 2012, to December 30, 2016, were included. Combined anterior and posterior segment procedures and surgeons with fewer than 50 cases were excluded. Anonymized data collected were demographics, anesthesia, operating time, surgeon grade, case complexity, pupil size, pupil expander or capsular tension ring (CTR) use, intraocular lens type, posterior capsule or zonular fiber rupture or dialysis, vitreous loss, and automated anterior vitrectomy. RESULTS: From 11 067 cases, 9552 (86.3%) had a recorded operating time. The mean ± SD operating times in minutes were as follows consultants 19 ± 10, junior 30 ± 11, intermediate 27 ± 12, senior trainees 24 ± 10, and fellows 31 ± 11. Operating time was significantly shorter for topical than for sub-Tenon or general anesthesia, especially among trainees. Consultant operating time remained unchanged with increasing case complexity, except for high-complexity cases. Small pupils, pupil expander or CTR use, posterior capsule or zonular fiber rupture or dialysis with or without vitreous loss (mean 45 ± 23) were associated with increased operating times. Iris hooks were associated with greater increases in operating time than Malyugin rings (16 minutes versus 6 minutes; P < .001). There was a modest 3-minute decrease in operating time among consultants over 5 years. CONCLUSION: Cataract surgery operating time was significantly influenced by anesthesia type, surgeon grade, high case complexity, pupil size, pupil expander use/type, CTR use, and intraoperative complications.