June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
Operative Time Variability in Retinal Detachment Surgery between Academic and Community Vitreoretinal Surgeons at a Single Surgery Center
Author Affiliations & Notes
  • Ryan Sameen Meshkin
    Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, United States
  • Jonah Blumenthal
    Harvard Medical School, Boston, Massachusetts, United States
  • Sandra Hoyek
    Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, United States
  • Eric Strand
    Harvard Medical School, Boston, Massachusetts, United States
  • Sarah Manz
    Harvard Medical School, Boston, Massachusetts, United States
  • Dennis Akrobetu
    Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, United States
  • Yilin Feng
    Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, United States
  • Nimesh A. Patel
    Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, United States
  • Footnotes
    Commercial Relationships   Ryan Meshkin None; Jonah Blumenthal None; Sandra Hoyek None; Eric Strand None; Sarah Manz None; Dennis Akrobetu None; Yilin Feng None; Nimesh Patel None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 5274. doi:
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      Ryan Sameen Meshkin, Jonah Blumenthal, Sandra Hoyek, Eric Strand, Sarah Manz, Dennis Akrobetu, Yilin Feng, Nimesh A. Patel; Operative Time Variability in Retinal Detachment Surgery between Academic and Community Vitreoretinal Surgeons at a Single Surgery Center. Invest. Ophthalmol. Vis. Sci. 2023;64(8):5274.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Irrespective of practice setting, economic pressures have steered physicians to prioritize efficiency and reduce cost while preserving quality of care. We performed a retrospective, observational clinical study to learn about differences in operative times and case characteristics of surgeons practicing across various settings.

Methods : Primary retinal detachment (RD) repair surgeries performed at Massachusetts Eye and Ear over a 3-year period (2019-2021) were reviewed. A random sample of 20 vitreoretinal surgeons distributed evenly among those practicing in either an "academic" or "community" setting was selected. Fifteen consecutive primary RD repair surgeries were contributed by each surgeon if they met the following inclusion criteria: patients greater than 21 years of age without prior retinal surgery. Clinical characteristics were collected. Primary outcome measures were length of surgery and presence of a fellow. Comparisons were made using unpaired t-tests, chi-square, and ANOVA statistical tests. Variables significantly associated with longer operative time were identified using linear regression analysis.

Results : Of 300 primary RD repair surgeries performed by 10 academic and 10 community surgeons, fellows were present in 225 surgeries (75%), which comprised all academic surgeon cases and 50% of community surgeon cases. For all surgeries, the mean operation length was 69.2±30.8 minutes. It was shorter for non-fellow community surgeon cases (55.0±24.1) than either academic (73.0±30.8) or community surgeon cases with fellows (75.7±32.5) (p<.001). Combined SB-pars plana vitrectomy (PPV) repairs were performed more frequently by academic surgeons than community surgeons (84% vs. 16%, p<.001). There was a significant difference between academic and community surgeons in percentage of macula-off RDs (academic: 58.0%, community: 41.9%; p=.002). A linear regression analysis yielded the following covariates as significantly associated with greater surgery time (all p<.05): addition of a scleral buckle (β=32.6) or membrane peel (β=18.5), presence of a fellow (β=14.5), proliferative vitreoretinopathy (β=12.8), and greater number of retinal breaks (β=2.4).

Conclusions : RD repair cases performed by academic surgeons have longer operative times. This is likely due to the complexity of detachments, the addition of a scleral buckle and fellow participation.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

 

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