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Daniel Gologorsky, Timothy G Murray; Evaluating surgical efficiency in the transition from the Accurus to the Constellation Vision System for microincisional vitrectomy surgery (MIVS) from an operations management perspective. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5583. doi: https://doi.org/.
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This study compares surgical efficiencies, complications, and user perceptions associated with the transition from the Accurus to the next generation Constellation platform. The results are evaluated from an operations management framework.
Electronic health records were obtained for all vitreoretinal surgical procedures at the Bascom Palmer Eye Institute during two discrete 12-month time periods, each reflecting dedicated usage of the Accurus and Constellation Vision systems. Data were limited to a single surgeon and evaluated on a number of metrics related to surgical efficiency. All records were evaluated for intraoperative complications.
Over a two-year study period, 514 eligible patients who underwent MIVS were identified: 281 with the Accurus and 233 with the Constellation. The transition in platforms was accompanied by statistically significant measures: an increase in the total number of patients operated on per day, a decrease in operating room time, and a decrease in MIVS procedure time. Combined MIVS/phacoemulsification surgery saw similar declines in surgical room and procedure times. No increases in surgery-related complications were noted by quality assurance reviews.
Statistically significant improvements were noted in three important measures of surgical efficiency: operative number of patients per day, operating room time, and surgical procedure time. These improvements reflect the positive impact of the combined and integrated, posterior and anterior, Constellation surgical platform. Hospital quality assurance review and surgeon evaluation of operative complications showed no increased safety or setup concerns during the transition. Operations management and queuing theory maintain that such an improvement in surgical capacity alone should lead to a valuable decrease in patient wait times. Revenues can be generated by increasing surgical volume, assuming the additional category of procedure yields a positive net present value. Increased revenues can be shunted toward alleviating bottlenecks in production by hiring staff or purchasing additional equipment. Ultimately, improved efficiency can be geared towards improving quality of care, decreasing costs, increasing revenues, improving employee conditions, or providing a valuable marketing opportunity.
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