ABSTRACT
Purpose: Surgical procedure packs are commonly used in ophthalmological surgeries, but quantitative evidence demonstrating the time efficiency and economic impact of their use is limited. Evaluating the time and cost of surgical pack use is particularly important for publicly funded healthcare systems with tight budgets and/or an emphasis on value-based care. This study sought to estimate the economic impact of comprehensive surgical pack use in cataract and vitreoretinal (retina) surgeries across operating room (OR), materials management, and accounting departments in Canada. Methods: A budget impact model developed for the United States (US) from a self-reported cross-sectional study was adapted for Canada. The US study obtained data via an online survey and timing exercises of surgical procedures. The model was adapted using relevant Canadian-specific labor and cost inputs. Use of generic commodity packs (no proprietary equipment-specific supplies) was compared to full utilization of Custom-Pak®, a comprehensive pack (disposables plus equipment-specific supplies) in cataract and retina surgeries at the facility and aggregate group (provincewide) levels. Results: Switching from generic to comprehensive pack use in all 2500 cataract procedures at a community hospital saves 287 labor hours per year, primarily in the materials management department. Surgery preparation (OR) hours saved allow for an additional 196 potential procedures annually. Most of the Canadian Dollar (CAD) $39,815 annual cost savings are realized for the OR. Aggregating across 50,000 cataract surgeries at the provincial level yields savings of 5608 hours and 3916 additional procedures, translating to hidden cost reductions of CAD$790,632 annually. Implementing full Custom-Pak use at the facility level in 1000 retina cases saves $10,650 annually; provincewide, 127 potential additional procedures can be gained. Conclusion: Comprehensive Custom-Pak use improves efficiency in cataract and retina surgeries saving substantial time and cost in Canadian hospitals, potentially allowing more patients to have these procedures, and reducing wait times.
ABSTRACT
OBJECTIVE: To assess the role of patient choice in influencing wait time for cataract surgery. DESIGN: Cross-sectional study. PARTICIPANTS: 496 patients aged ≥40 years presenting to Kensington Eye Institute in Toronto for cataract surgery in 2010-2011. METHODS: Patients were invited to complete a self-administered questionnaire about their experience with wait time management, sociodemographics, and satisfaction with wait time. Differences in median wait time were statistically tested with the Wilcoxon test. Factors associated with declining the first available surgery date were analyzed with prevalence ratios (PR) and 95% confidence intervals (CIs). RESULTS: Overall, 90% of patients had surgery within 21 weeks; 16% experienced a wait longer than the pan-Canadian benchmark (16 weeks). The median wait time was 8 weeks. Altogether, 21% declined the first available surgery date. Major reasons included planned travel/holidays (35%), family responsibilities (14%), and earlier date became available (13%). Excluding those with "earlier date became available" and "cancellation by surgeon," the proportion declining the first available date decreased to 18%. In multivariate analysis, individuals with a college/university education were 60% more likely to decline (PR 1.6, 95% CI 1.0-2.5). Conversely, individuals living alone were 50% less likely to decline (PR 0.5, 95% CI 0.3-0.9). The median wait time was 2.5 weeks longer for those who declined than for those who accepted (8.5 vs 6 weeks; p = 0.02). CONCLUSIONS: One in 5 patients declined the first available date for cataract surgery in 2010-2011 in Toronto. As wait time for cataract surgery improves, patient choice seems to play a greater role in influencing the wait.