Preloaded vs manually loaded IOL delivery systems in cataract surgery in the largest ambulatory surgery center of northwestern China: an efficiency analysis

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Abstract

Background

To compare the efficiency of preloaded vs manually loaded IOL (P-IOL vs M-IOL, respectively) delivery systems in cataract surgery in the largest ambulatory surgery center of Northwestern China.

Methods

A total of 200 cases were included in this prospective, observational study. Time and motion data were collected in a one- or two-operating room (1-OR or 2-OR, respectively) scenario. A model of the efficiency and revenue implications of introducing a preloaded delivery system for IOLs in cataract surgery was used to estimate the changes in cataract throughput and hospital revenue through transitioning from the M-IOL delivery system to the P-IOL system.

Results

In the 1-OR scenario, the mean total case time was 16.9 min using P-IOL, which was a 7.7% reduction compared with M-IOL ( P < 0.01). In the 2-OR scenario, the mean total surgeon time was 10.8 min using P-IOL, which was a 7.8% reduction compared with M-IOL ( P < 0.05). By switching from M-IOL to P-IOL, annual throughput will increase by 5.2% (960 cases) in the 1-OR scenario and 7.7% (1440 cases) in the 2-OR scenario, accompany by an increase in revenue of approx. 284,352 USD in the 1-OR scenario and approx. 426,528 USD in the 2-OR scenario.

Conclusion

This report is the first of a comparison of two IOL delivery systems in China using different settings in the scenario. IOL delivery with preloaded systems is time saving in both the 1-OR scenario and the 2-OR scenario. Moreover, switching from the M-IOL delivery system to the P-IOL system holds potential to increase cataract throughput and hospital revenue.

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Most cited references 15

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Global estimates of visual impairment: 2010.

Donatella Pascolini, Silvio Paolo Mariotti (2012)

From the most recent data the magnitude of visual impairment and its causes in 2010 have been estimated, globally and by WHO region. The definitions of visual impairment are the current definitions of presenting vision in the International Classification of Diseases version 10. A systematic review was conducted of published and unpublished surveys from 2000 to the present. For countries without data on visual impairment, estimates were based on newly developed imputation methods that took into account country economic status as proxy. Surveys from 39 countries satisfied the inclusion criteria for this study. Globally, the number of people of all ages visually impaired is estimated to be 285 million, of whom 39 million are blind, with uncertainties of 10-20%. People 50 years and older represent 65% and 82% of visually impaired and blind, respectively. The major causes of visual impairment are uncorrected refractive errors (43%) followed by cataract (33%); the first cause of blindness is cataract (51%). This study indicates that visual impairment in 2010 is a major health issue that is unequally distributed among the WHO regions; the preventable causes are as high as 80% of the total global burden.

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Cataracts.

Yu-Chi Liu, Boris Malyugin, Terry Kim … (2017)

An estimated 95 million people worldwide are affected by cataract. Cataract still remains the leading cause of blindness in middle-income and low-income countries. With the advancement of surgical technology and techniques, cataract surgery has evolved to small-incisional surgery with rapid visual recovery, good visual outcomes, and minimal complications in most patients. With the development of advanced technology in intraocular lenses, the combined treatment of cataract and astigmatism or presbyopia, or both, is possible. Paediatric cataracts have a different pathogenesis, surgical concerns, and postoperative clinical course from those of age-related cataracts, and the visual outcome is multifactorial and dependent on postoperative visual rehabilitation. New developments in cataract surgery will continue to improve the visual, anatomical, and patient-reported outcomes. Future work should focus on promoting the accessibility and quality of cataract surgery in developing countries.

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Global cost-effectiveness of cataract surgery.

John W. M. Martens, Van Lansingh, J. Carter (2007)

To determine the cost-effectiveness of cataract surgery worldwide and to compare it with the cost-effectiveness of comparable medical interventions. Meta-analysis. Approximately 12,000 eyes in the studies selected. Articles were identified by searching the literature using the phrase cataract surgery, in combination with the terms cost, cost-effectiveness, and cost-utility. Terms used for the comparable medical interventions search included epileptic surgery, hip arthroplasty, knee arthroplasty, carpal tunnel surgery, and defibrillator implantation. The search was restricted to the years 1995 through 2006. Cataract surgery costs were converted to 2004 United States dollars (US$). Cost-utility was calculated using: (1) costs discounted at 3% for 12 years with a discounted quality-adjusted life years (QALY) gain of 1.25 years, and (2) costs discounted at 3% for 5 years with a discounted QALY gain of 0.143 years. The Cataract Surgery Affordability Index (CSAI) for each country was calculated by dividing the cost of cataract surgery by the gross national income per capita for the year 2004. Cost-utility in 2004 US$/QALY and affordability of cataract surgery relative to the United States. Cost-utility values for cataract surgery (first eye) varied from $245 to $22,000/QALY in Western countries and from $9 to $1600 in developing countries. In developed countries, the cost-effectiveness of cataract surgery estimated by Choosing Interventions That Are Cost Effective ranged from, in international dollars (I$), I$730 to I$2400/disability-adjusted life years (DALY) averted, and I$90 to I$370/DALY averted in developing countries. The CSAI varied from 17% to 189% in developed countries and 29% to 133% in developing countries compared with the United States. The cost-utility of other comparable medical interventions was: epileptic surgery, $4000 to $20,000/QALY; hip arthroplasty, $2300 to $4800/QALY; knee arthroplasty, $6500 to $12,700/QALY; carpal tunnel surgery, $140 to $280/QALY; and defibrillator implantation, $700 to $23,000/QALY. The cost-utility of cataract surgery varies substantially, depending how the benefit is assessed and on the duration of the assumed benefit. Cataract surgery is comparable in terms of cost-effectiveness to hip arthroplasty, is generally more cost-effective than either knee arthroplasty or defibrillator implantation, and is cost-effective when considered in absolute terms. The operation is considerably cheaper in Europe and Canada compared with the United States and is affordable in many developing countries, particularly India.

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Author and article information

Contributors

Hong Yan: yhongb@fmmu.edu.cn

Journal

Journal ID (nlm-ta): BMC Ophthalmol

Journal ID (iso-abbrev): BMC Ophthalmol

Title: BMC Ophthalmology

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2415

Publication date (Electronic): 1 December 2020

Publication date PMC-release: 1 December 2020

Publication date Collection: 2020

Volume: 20

Electronic Location Identifier: 469

Affiliations

[1 ]GRID grid.440588.5, ISNI 0000 0001 0307 1240, Xi’an Fourth Hospital, Shaanxi Eye Hospital, Affiliated Xi’an Fourth Hospital, , Northwestern Polytechnical University, ; Xi’an, 710004 Shaanxi Province China

[2 ]GRID grid.7700.0, ISNI 0000 0001 2190 4373, Department of Ophthalmology, , University of Heidelberg, ; 69120 Heidelberg, Germany

Article

Publisher ID: 1721

DOI: 10.1186/s12886-020-01721-5

PMC ID: 7708187

PubMed ID: 33261575

SO-VID: 60e04e0b-ed57-41b7-b17c-2f1452a8c6aa

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 20 May 2020

Date accepted : 9 November 2020

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100013076, National Major Science and Technology Projects of China;

Award ID: 2017YFC1104500

Award Recipient : Hong Yan

Funded by: FundRef http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;

Award ID: 81873674

Award Recipient : Hong Yan

Funded by: Xi'an Fourth Hospital Research Incubation Fund

Award ID: LH-6

Award Recipient : Hong Yan

Custom metadata

ScienceOpen disciplines: Ophthalmology & Optometry

Keywords: preloaded intraocular lens,cataract,cataract throughput,hospital revenue

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ScienceOpen disciplines: Ophthalmology & Optometry

Keywords: preloaded intraocular lens, cataract, cataract throughput, hospital revenue

Preloaded vs manually loaded IOL delivery systems in cataract surgery in the largest ambulatory surgery center of northwestern China: an efficiency analysis

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Abstract

Background

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Conclusion

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Karger: Ophthalmology

Most cited references 15

Global estimates of visual impairment: 2010.

Cataracts.

Global cost-effectiveness of cataract surgery.

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