[Cost of teaching cataract surgery in a public hospital]

Abstract

Introduction: The gold standard of cataract surgery, phacoemulsification is the most commonly performed surgical procedure in France. Surgical instruction often takes place in the operating room where residents and fellows perform real surgery, supervised by an experienced surgeon. The goals of this study were double: evaluate surgical times according to the person performing the surgery, in order to quantitate the cost incurred by teaching and compare complication rate between surgeons.

Methods: A retrospective single center study was performed at Simone-Veil Hospital, Eaubonne-Montmorency, France. Over a period of 13 consecutive weeks from January to March 2016, all patients who underwent phacoemulsification for cataract extraction were included. Patients were separated into three groups, according to the primary surgeon: group S for Senior was composed of two experienced surgeons who typically performed over 500 procedures per year; group A for assistant was composed of three residents who performed less than 500 procedures per year; 2 inexperienced interns constituted group I. Surgery duration was recorded by the OR nurse in minutes between the first incision and removal of the lid speculum. The cost of operating room time was estimated at seven euros per minute. The occurrence of complications was determined from the operative report.

Results: 408 cataract surgeries were performed during the study period, divided into 156 eyes in group S, 142 in group A and 110 surgeries in group I. The mean age at surgery was 74.1±9 years (39-95), comparable in the 3 groups. The operative time was significantly shorter in group S (11.7min) than in A (18.7min; P<0.001) and in I (18.8min; P<0.001). The complication rate was higher in group I than in group S (P=0.03). The average additional cost related to the lengthening of the teaching procedure was 49 euros for Group A and 49.7 euros for Group I.

Discussion: The hospital reimbursement for cataract surgery is higher in the public sector than in the private sector; it can absorb the cost of university training.

Conclusion: Teaching cataract surgery entails an additional financial cost for the hospital. It is also responsible for a higher human cost due to a greater number of operative complications with interns.

Keywords: Capsular tear; Cataract surgery; Chirurgie de la cataracte; Enseignement chirurgical; Health care cost; Phacoemulsification; Phacoémulsification; Rupture capsulaire; Teaching surgery; Économie de la santé.