Service d'Ophtalmologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France.
BMJ Open. 2013 May 8;3(5):e002497. doi: 10.1136/bmjopen-2012-002497.
Surgery duration is a source of preoperative anxiety for patients undergoing cataract surgery. To better inform patients, we evaluated the agreement between objective and patient-perceived surgery durations.
Case series.
Public teaching university hospital (Paris, France).
During the study period, 368 cataract surgery cases performed on 285 patients were included, 85 cases were excluded from the final analysis. All patients who had uneventful phacoemulsification were included. Cases with any significant intraoperative adverse event or cases requiring additional anaesthesia other than topical were excluded. Resident performed cases were also excluded.
Procedures were timed (objective duration) and patients were asked, immediately afterwards, to assess the duration of their surgery (patient-assessed duration). The agreement between objective and patient-assessed durations as well as influencing factors was studied.
Mean objective duration (13.9±5 min) and patient-assessed duration (15.3±6.9 min) were significantly correlated (Spearman's r=0.452, p<0.0001). Furthermore, Bland-Altman analysis and the intraclass correlation coefficient (0.341, 95% CI 0.23 to 0.44) were quite in agreement. On univariate analysis, senior-performed procedures were significantly shorter than those performed by juniors (13.4 vs 17.8 min, p=0.0001). Pain was recorded as 'no sensation' (31.5% of the cases), 'mild sensation' (41%), 'moderate pain' (23.3%), 'intense pain' (3.5%) and 'unbearable pain' (0.7%). Groups with high pain score had significantly longer procedures (p<0.001). Multivariate analysis revealed that the only independent factors associated with both the objective and patient-assessed durations of surgery were surgeon's experience and pain-score.
In our study, patients' estimated and real duration of the surgery showed moderate agreement, suggesting that emotions associated with eye surgery under topical anaesthesia did not dramatically hinder the patients' perception of time. However, the benefit of preoperative counselling regarding the duration of surgery will need further evaluation.
手术时间是白内障手术患者术前焦虑的一个来源。为了更好地告知患者，我们评估了客观手术时间和患者感知手术时间之间的一致性。
病例系列。
法国巴黎的公立教学医院。
在研究期间，共纳入了 285 名患者的 368 例白内障手术，其中 85 例被排除在最终分析之外。所有接受顺利超声乳化的患者均被纳入。排除术中出现任何重大不良事件或需要除局部麻醉外的其他麻醉的病例。也排除住院医生进行的手术。
对手术进行计时（客观时间），并在手术结束后立即询问患者对手术时间的评估（患者评估时间）。研究了客观时间和患者评估时间之间的一致性以及影响因素。
平均客观时间（13.9±5 分钟）和患者评估时间（15.3±6.9 分钟）呈显著相关（Spearman 相关系数=0.452，p<0.0001）。此外，Bland-Altman 分析和组内相关系数（0.341，95%置信区间 0.23 至 0.44）非常一致。单因素分析显示，高年资医生进行的手术明显短于低年资医生（13.4 分钟对 17.8 分钟，p=0.0001）。疼痛被记录为“无感觉”（31.5%的病例）、“轻度感觉”（41%）、“中度疼痛”（23.3%）、“剧烈疼痛”（3.5%）和“难以忍受的疼痛”（0.7%）。疼痛评分高的组手术时间明显更长（p<0.001）。多因素分析显示，与手术客观时间和患者评估时间相关的唯一独立因素是医生的经验和疼痛评分。
在我们的研究中，患者估计的手术时间和实际手术时间之间存在中等程度的一致性，这表明局部麻醉下眼手术相关的情绪并没有显著阻碍患者对时间的感知。然而，关于手术持续时间的术前咨询的好处需要进一步评估。
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