Department of Ophthalmology, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan.
Department of Strategic Operating Room Management and Improvement, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan.
BMJ Open. 2019 Jun 14;9(6):e028656. doi: 10.1136/bmjopen-2018-028656.
To investigate the impact of standardisation of the perioperative protocol based on the Joint Commission International (JCI) accreditation guidelines for operating time in cataract surgery.
Retrospective observational study.
Single centre in Japan.
Between March 2014 and June 2016, 3127 patients underwent cataract surgery under topical anaesthesia including 2581 and 546 patients before and after JCI accreditation, respectively.
We compared three time periods, comprising the preprocedure/surgery time (pre-PT), PT and post-PT, and total PT (TPT) of cataract surgery between patients before and after JCI accreditation, by regression analysis adjusted for age, sex and cataract surgery-associated confounders.
The main outcomes were pre-PT, PT, post-PT and TPT. Pre-PT (19.8±10.5 vs 13.9±8.5 min, p<0.001) and post-PT (3.5±4.6 vs 2.6±2.1 min, p<0.001) significantly decreased after JCI accreditation, while PT did not significantly change (16.8±6.7 vs 16.2±6.3 min, p=0.065). Consequently, TPT decreased on average by 7.3 min per person after JCI accreditation (40.1±13.4 vs 32.8±10.9 min, p<0.001). After adjusting for confounders, pre-PT (β=-5.82 min, 95% CI -6.75 to -4.88), PT (β=-0.76 min, 95% CI -1.34 to -1.71), post-PT (β=-0.85 min, 95% CI -1.24 to -0.45) and TPT (β=-7.43 min, 95% CI -8.61 to -6.24) were significantly shortened after JCI accreditation.
Perioperative protocol standardisation, based on JCI accreditation, shortened TPT in cataract surgery under local anaesthesia.
研究基于国际联合委员会（JCI）认证标准的围手术期方案标准化对白内障手术中手术时间的影响。
回顾性观察性研究。
日本的一个单一中心。
2014 年 3 月至 2016 年 6 月期间，3127 名患者接受了局部麻醉下白内障手术，其中 2581 名和 546 名患者分别在 JCI 认证前和认证后接受了手术。
我们通过回归分析比较了认证前后患者三个时间段（术前/手术前时间[pre-PT]、PT 和 post-PT 以及总 PT [TPT]），调整了年龄、性别和白内障手术相关混杂因素。
主要结局是 pre-PT、PT、post-PT 和 TPT。JCI 认证后，pre-PT（19.8±10.5 分钟比 13.9±8.5 分钟，p<0.001）和 post-PT（3.5±4.6 分钟比 2.6±2.1 分钟，p<0.001）显著缩短，而 PT 无显著变化（16.8±6.7 分钟比 16.2±6.3 分钟，p=0.065）。因此，JCI 认证后，平均每人 TPT 减少 7.3 分钟（40.1±13.4 分钟比 32.8±10.9 分钟，p<0.001）。调整混杂因素后，pre-PT（β=-5.82 分钟，95%置信区间-6.75 至-4.88）、PT（β=-0.76 分钟，95%置信区间-1.34 至-1.71）、post-PT（β=-0.85 分钟，95%置信区间-1.24 至-0.45）和 TPT（β=-7.43 分钟，95%置信区间-8.61 至-6.24）在 JCI 认证后明显缩短。
基于 JCI 认证的围手术期方案标准化缩短了局部麻醉下白内障手术的 TPT。
