Introducing high volume cataract surgery in Hong Kong: improving surgeon efficiency without sacrificing patient safety

Abstract

There is an increasing demand for cataract surgery in the Hospital Authority due to the aging population in Hong Kong. The introduction of high volume cataract surgery is aimed at increasing efficiency of service by reducing turnover time in between operations. This allows for more operations to be performed per allocated time slot. Furthermore, regular participation in high volume surgery, as evidenced by results in other specialties, may improve individual surgeon competency and efficiency. A prospective audit was performed on patients who underwent cataract surgery at Grantham Cataract Centre between 1st January 2010 to 31st December 2011. Operative records of the patients were reviewed for the study and separated according to surgeon. Analysis was restricted to surgeons, who were registered specialists in ophthalmology, and performed at least 600 cataract surgeries during the study period. Exclusion criteria included surgeries performed on resident training lists, or by more than one surgeon; and either extracapsular or intracapsular cataract extraction was the primary procedure. Four monthly average operating times were calculated for each surgeon and compared over time. A total of six surgeons met the inclusion criteria for the study. Average operative time during the first quadrimester was 21:21. There was a stepwise reduction on subsequent quadrimesters: 19:43, 18:22, 18:13, 16:40 and 16:03. Controlled for individual surgeons, the step-wise reduction in operative time remained. A similar relationship with phacoemulsification time was observed during the study period. The intraoperative posterior capsular rupture and/or vitreous loss rate was also shown to decline with duration of involvement in high volume surgery. Surgeon participation in high volume cataract surgery is associated with reduction in individual operating time and intraoperative complication rate. There was no evidence of a learning curve in the initial study period.