Abstract
Purpose :
To assess the impact of surgical volume on ophthalmic surgeon efficiency and the relative efficiency of gauge size in pars plana vitrectomy surgeries performed on the Bausch + Lomb Stellaris® PC platform.
Methods :
Machine logistics of Bausch + Lomb’s Stellaris® devices were collected from over 1,550 machines across multiple institutions and included 114,737 posterior ophthalmic surgeries conducted by 2,278 surgeons from 2002 to 2017. Descriptive statistical analysis was then performed on the collected data. Surgical volume was classified into three groups: high volume (HV) (≥ 20 surgeries per month), intermediate volume (IV) (6 to 19), and low volume (LV) (≤ 5). Surgical measures, including surgery time, laser, aspiration and vitrectomy parameters, were compared based on surgeon volume and gauge (G) size.
Results :
HV surgeons had the lowest average surgical effective time (51.0±34.0 min, N=25,780) compared to IV (57.1±35.7 min, N=52,607) and LV (71.4±48.0 min, N=34,199) surgeons (P<0.01). IV surgeons had the lowest average vitrectomy time (373.7±300.5 sec, N=48,873) versus HV (394.1±289.4 sec, N=23,866) and LV (450.2±361.5 sec, N=30,960) surgeons (P < 0.01). LV surgeons had a higher average aspirating duration (621.5±495.2 sec, N=31,422) than either IV (504.4±372.6 sec, N=49,496) or HV (506.4±358.3 sec, N=24,243) surgeons (P<0.01). LV surgeons also had higher average surgical laser time and higher average power settings than either IV or HV surgeons (P<0.01). On average, 25G surgeries required the least amount of fluid (51.9 mL, N=25,022) compared to 23G (63.8±38.9 mL, N=45,962) and 20G (70.8±42.9 mL, N=22,455) surgeries (P<0.01). 25G surgeries also had a shorter average vitrectomy time (349.0±266.9 sec, N=27,366) compared to 23G (409.9±324.3 sec, N=51,527) or 20G (440.5±352.2 sec, N=24,157) surgeries (P<0.01). Finally, HV surgeons using 25G needles had higher average cut rates during surgery (4244±834.0 cuts/min) than those using 23G (3778±1365 cuts/min) or 20G (3268±1465 cuts/min) needles (P<0.01).
Conclusions :
In this large vitrectomy surgery database, high volume ophthalmic surgeons had the greatest measures of surgical efficiency based on vitrectomy parameters collected by the Stellaris® machines. Additionally, 25G surgeries were associated with the lowest average fluid usage and shortest average vitrectomy time compared to other gauges.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.