Preloaded IOL delivery system results in time savings per case, surgeon

Take-home message: Use of a new preloaded IOL delivery system for routine cataract surgeries in a multicenter study resulted in time savings per case and per surgeon that could reduce costs per case or increased profit.

By Nancy Groves; Reviewed by Guillermo Rocha, MD, FRCSC

Brandon, Manitoba, Canada-Significant reductions in total case time and surgeon lens time for a new preloaded IOL delivery system (Tecnis iTec, Abbott Medical Optics) were confirmed in a recent study.

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The multisite time and motion study compared a manually loaded delivery system with the preloaded device, which was designed to improve efficiency in the operating room.

Third-party observers collected intraoperative time and motion data for all surgical staff before and after adoption of the system at three centers: a single-operating room set-up in Manitoba, Canada, where about 10 or 11 cataract procedures were performed per day; a two-operating room set-up in France, capable of handling about 18 cases per day; and a two-room site in Iowa where about 25 procedures could be performed per day.

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A minimum of 20 cataract surgeries with manually loaded IOLs were performed, followed by training for the physicians and surgical staff on use of the system, then an additional series of surgeries using the preloaded device. About 154 surgeries were performed in all.

Guillermo Rocha, MD, FRCSC, GRMC Vision Centre, Brandon, Manitoba, Canada, performed all the surgeries at the Manitoba site; Jason J. Jones, MD, was the surgeon at the U.S. site, and Serge Zaluski, MD, performed the procedures in France.

Next: Total case time, surgeon lens time

The reduction in total case time was 12.0% in Canada (p<0.001), 9.4% in the United States (p < 0.001), and 6.2% in France (p < 0.05). The reductions in surgeon lens time were 43.7% in Canada, 31.9% in France, and 17.4% in the United States (all sites, p < 0.001). The mean difference was 0.8 minutes per case in Canada and 0.4 minutes at the sites in the United States and France.

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According to Dr. Rocha, the observers concluded that an average of 1.2 more cases per day could be performed at the Canadian site, which was a public hospital.

To put this difference in perspective, Dr. Rocha explained that if he performed cataract surgery at this hospital once a week, that would equate to 4 more cases a month or about 48 extra cases a year without stretching the hospital’s resources or hiring additional staff.

“It may not sound like much, but when we’re dealing with waiting lists (for surgery), any little bit that we can do is definitely significant,” Dr. Rocha said.

He also noted that performing the additional cases would result in little if any additional cost to the hospital system, since the operating room staff would already be on duty and paid for their time, and one additional case per day would not put undue pressure on the team.

Next: Improved efficiencies

The data analysis from the three sites showed that capital and labor cost efficiencies resulting from additional throughput reduced the mean cost per case by an estimated 2.4% in France and 4.2% in Canada. The revenue implications of additional throughput in the United States were estimated to increase profit by 5.3%. Time savings due to improved throughput were a gain of 4% in the United States, 5.7% in France, and 9.9% in Canada.

Dr. Rocha described the preloaded system as standard and almost “foolproof,” one that could be completed in three steps: injection of viscoelastic and cap removal, pushing the plunger to the dwell position, and depressing the plunger to insert the lens.

He explained that no time is wasted because the lens is loaded while the ophthalmologist is completing the surgery.

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A second benefit, which also helps improve efficiency, is that the device is a single-use system. The nurses do not have to remove the cartridge, clean the inserter, and send it to another department for sterilization, as with a reusable device. This also reduces the risk of infection or sterilization errors.

In addition, surgeons do not have to touch the lens, which could cause damage or contamination. And because the lens is encased in a disposable cartridge and inserter, there is minimal contact with the exterior as well.

“It’s a cleaner way of delivering the lens without it being exposed to any potential contaminants,” said Dr. Rocha, adding that the amount of contact with the lens was not an aspect of the study but rather his personal observation.

“For me, the most important thing was having a consistent and predictable way of delivering the lens, not wasting time preparing the lens and loading it but having it ready,” Dr. Rocha said. “Just as soon as I’m done, the nurse passes it to me and I inject it. That really has made my operating room days more efficient.”

Guillermo Rocha, MD, FRCSC

E: rochag@me.com

Dr. Rocha serves on the advisory board for Abbott Medical Optics (AMO) and is also a consultant and has received speaker honoraria. However, he did not receive any funding from AMO for this project, which was required as part of his relationship with the hospital where the study took place.