Effect of surgical case order on cataract surgery complication rates and procedure time

PurposeTo determine whether surgical warm-up affects cataract surgery complication rates and surgical case times.SettingUniversity of Washington Medicine Eye Institute, Harborview, Seattle, Washington, USA.DesignRetrospective case-control study.MethodsPatients who had phacoemulsification from June 2010 to December 2011 were consecutively reviewed. Case order for each surgeon was evaluated, comparing intraoperative complication rates and case times for attending and resident surgeons for the first case of the day (considered the warm-up case) versus subsequent cases. Simple (AMA Current Procedural Terminology code 66984) and complex (code 66982) phacoemulsification surgeries were included. Excluded were patients who had cataract surgery combined with another surgery. Pearson chi-square tests and 2-tailed independent-sample t tests were used to analyze data.ResultsThe study reviewed 1424 patients. Cataract surgery complication rates were not statistically different between the first cases of the day and subsequent cases (3.3% versus 4.0%) (P = .552). There was, however, a significant difference in mean case time between these groups. The mean case time for simple phacoemulsification by resident physicians was 49.45 minutes ± 19.38 (SD) for first cases and 42.27 ± 15.78 minutes for subsequent cases (P = .021) and by attending physicians, 32.54 ± 12.91 minutes and 26.69 ± 9.17 minutes, respectively (P <. 0001).ConclusionSurgical case order might not affect complication rates of cataract surgery; however, the first case of the day was longer than subsequent cases, suggesting that a preoperative warm-up exercise might decrease cataract surgery time.Financial DisclosureNeither author has a financial or proprietary interest in any material or method mentioned.