Epsom and St. Helier University, National Health Service Trust, Sutton, London, United Kingdom.
Epsom and St. Helier University, National Health Service Trust, Sutton, London, United Kingdom.
J Cataract Refract Surg. 2019 Jun;45(6):816-822. doi: 10.1016/j.jcrs.2019.01.002. Epub 2019 Mar 14.
To define factors affecting cataract surgery operating time for operating room planning, optimizing throughput, enhancing patient experiences, minimizing costs, and allocating training time.
Epsom and St. Helier University National Health Service Trust, London, United Kingdom.
Retrospective case series.
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.
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.
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.
为了进行手术室规划、优化流程、提升患者体验、降低成本和分配培训时间，确定影响白内障手术操作时间的因素。
英国伦敦埃普索姆和圣赫利尔国民保健信托基金会。
回顾性病例系列研究。
纳入 2012 年 1 月 1 日至 2016 年 12 月 30 日期间行原发性手动超声乳化白内障手术的所有患者。排除联合眼前段和后段手术以及手术例数少于 50 例的医生。收集的匿名数据包括人口统计学资料、麻醉方式、手术时间、医生级别、手术难度、瞳孔大小、瞳孔扩张器或囊张力环（CTR）的使用、人工晶状体类型、后囊膜或悬韧带破裂或撕裂、玻璃体液丢失以及自动前段玻璃体切除术。
在 11067 例患者中，有 9552 例（86.3%）记录了手术时间。记录的手术时间分钟平均值如下：顾问级医生为 19±10，初级医生为 30±11，中级医生为 27±12，高级培训医生为 24±10，研究员为 31±11。与局部麻醉相比，全身麻醉或球后麻醉下的手术时间明显缩短，尤其是在培训医生中。随着手术难度的增加，顾问级医生的手术时间保持不变，除了高难度病例。小瞳孔、瞳孔扩张器或 CTR 的使用、后囊膜或悬韧带破裂或撕裂伴或不伴玻璃体液丢失（平均 45±23 分钟）与手术时间延长相关。虹膜钩比 Malyugin 环导致的手术时间增加更多（16 分钟比 6 分钟；P<.001）。在 5 年内，顾问级医生的手术时间平均减少 3 分钟。
白内障手术操作时间明显受麻醉方式、手术医生级别、手术难度大、瞳孔大小、瞳孔扩张器的使用/类型、CTR 的使用以及术中并发症的影响。
