From the Department of Ophthalmology, Massachusetts Eye and Ear Infirmary (McKay, Borkar, Moustafa, Kloek), Department of Epidemiology, Boston University School of Public Health (Haviland), Boston, Massachusetts, and Wills Eye Hospital Retina Service (Borkar), Philadelphia, Pennsylvania, USA.
J Cataract Refract Surg. 2020 Jan;46(1):14-19. doi: 10.1016/j.jcrs.2019.08.004.
To identify preoperative clinical characteristics affecting cataract surgery operative time.
Academic center.
Large-scale retrospective cohort study.
All cases of cataract extraction by phacoemulsification and intraocular lens insertion performed by Comprehensive Ophthalmology at Massachusetts Eye and Ear between January 1, 2014, and December 31, 2014, were reviewed. Clinically relevant predictors of operative time were identified a priori, and a multivariate analysis was used to identify which predictors were associated with operative time. To quantify the surgeon effect, 2 regression models were built, one inclusive of surgeon identity and the other with years of experience and the training level of the supervised resident instead of identity.
Overall, 1349 cataract surgeries in 1072 patients were included. The mean operative time was 22.1 ± 7.8 minutes. Multiple clinical factors were significantly associated with operative time, with attending surgeon identity being the most important. In the multivariate model with surgeon identity, longer operative time was associated with male sex, increased body mass index, first-eye surgery, left operative eye, advanced cataract, use of iris hooks, use of Malyugin ring, use of trypan blue, history of diabetic retinopathy, short axial length, and shallow anterior chamber depth. The R value for the model inclusive of attending identity was 0.42, significantly higher than the R value of 0.23 for the model exclusive of identity.
Preoperative clinical characteristics, such as patient demographics, biometry data, and cataract severity, significantly correlate with operative time. Surgeon identity is highly correlated with operative time. Incorporating these results into predictive algorithms may allow for more predictable surgical scheduling and more efficient use of operative resources.
确定影响白内障手术时间的术前临床特征。
学术中心。
大规模回顾性队列研究。
回顾了 2014 年 1 月 1 日至 2014 年 12 月 31 日期间在马萨诸塞眼耳综合眼科进行的所有超声乳化白内障吸除术和人工晶状体植入术。预先确定了与手术时间相关的临床相关预测因素，并进行了多变量分析，以确定哪些预测因素与手术时间相关。为了量化外科医生的影响，构建了 2 个回归模型，一个包含外科医生身份，另一个包含经验年限和监督住院医师的培训水平，而不是身份。
共纳入 1072 例患者的 1349 例白内障手术。平均手术时间为 22.1±7.8 分钟。多项临床因素与手术时间显著相关，其中主治外科医生身份是最重要的因素。在包含外科医生身份的多变量模型中，手术时间较长与男性、体重指数增加、第一眼手术、左眼手术、严重白内障、虹膜钩的使用、Malyugin 环的使用、使用蓝丁胶、糖尿病视网膜病变病史、短眼轴和浅前房深度有关。包含主治医生身份的模型的 R 值为 0.42，明显高于不包含身份的模型的 R 值 0.23。
术前临床特征，如患者人口统计学、生物测量数据和白内障严重程度，与手术时间显著相关。外科医生的身份与手术时间密切相关。将这些结果纳入预测算法可能允许更可预测的手术安排和更有效地利用手术资源。
