Cataract Surgery Cancellations: An Analysis of Financial and Resident Training Implications at a Major Eye Institution

Abstract

Purpose The objective of this study was to assess reasons for cancellation of resident-performed cataract surgery, identify modifiable barriers to completion of the surgery on the scheduled date, and analyze the healthcare reimbursements and educational experiences lost as a result of cancellations.

Setting General eye clinic staffed by residents in a major urban center.

Design Retrospective, observational study.

Methods The study compared patients (older than 18 years) who canceled their cataract surgery to patients who underwent surgery on their scheduled date. Cancellation and reimbursement information was obtained from the surgical coordinator's scheduling book and billing information. Demographic information was obtained from patient electronic medical records, and scheduling logs. A brief phone survey was implemented to identify patient's barriers to surgery if a reason for cancellation was undocumented.

Results The overall cancellation rate over 1-year was 29.54% and most common overall reason for cancellation was that preadmission testing (PAT) was not completed in time for the procedure. Overall, 72% of the cancellations were made within 7 days of the surgery. The total estimated lost potential reimbursement due to cancellation was $844,370. The relative loss of surgical opportunities for residents throughout this 1-year period was 230 cases or 29 surgeries per resident.

Conclusion These findings have prompted a new study testing whether on-site mandatory PATs conducted on the same day as the patient's ophthalmology evaluation will reduce cataract surgery cancellation rates.

Keywords

cataract surgery cancellation - cataract surgery - resident training - reimbursement information - preadmission testing - cancellation rate - surgical opportunities

Authors' Contributions

Sneha Padidam: Acquisition, analysis, and interpretation of data; drafting of the manuscript; and administrative, technical, or material support.

Douglas Wisner: Conception and design of the study; acquisition, analysis, and interpretation of data; drafting of the manuscript; statistical analysis; critical revision of the manuscript; obtaining funding; administrative, technical, and material support; and supervision of the study.

Brianna Kenney: Conception and design of the study, drafting of the manuscript, obtaining funding, and supervision of the study.

Jared Peterson: Conception and design of the study; acquisition, analysis, and interpretation of data; critical revision of the manuscript; obtaining funding; administrative, technical, and material support; and supervision of the study.

Laura Pizzi: Conception and design of the study; acquisition, analysis, and interpretation of data; statistical analysis; drafting and critical revision of the manuscript; and administrative, technical, or material support.

Benjamin E. Leiby: Analysis and interpretation of data, critical revision of the manuscript, and statistical analysis.

Robert Bailey: Conception and design of the study; acquisition, analysis, and interpretation of data; critical revision of the manuscript; obtaining funding; administrative, technical, and material support; and supervision of the study.

Wills Cataract Research Group: Conception and design of the study; acquisition, analysis, and interpretation of data; statistical analysis; drafting and critical revision of the manuscript; administrative, technical, or material support; obtaining funding; administrative, technical, and material support; and supervision of the study.

Funding Source

Wills Eye Innovation Research Grant (grant number: INV #12–025). The funder had no role in the following: design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

• References

• 1 Pascolini D, Mariotti SP. Global estimates of visual impairment: 2010. Br J Ophthalmol 2012; 96 (05) 614-618
• 2 Congdon N, O'Colmain B, Klaver CC. , et al; Eye Diseases Prevalence Research Group. Causes and prevalence of visual impairment among adults in the United States. Arch Ophthalmol 2004; 122 (04) 477-485
• 3 Clark A, Morlet N, Ng JQ, Preen DB, Semmens JB. Whole population trends in complications of cataract surgery over 22 years in Western Australia. Ophthalmology 2011; 118 (06) 1055-1061
• 4 Busbee BG, Brown MM, Brown GC, Sharma S. Incremental cost-effectiveness of initial cataract surgery. Ophthalmology 2002; 109 (03) 606-612 , discussion 612–613
• 5 Tseng VL, Yu F, Lum F, Coleman AL. Risk of fractures following cataract surgery in Medicare beneficiaries. JAMA 2012; 308 (05) 493-501
• 6 Ayaki M, Muramatsu M, Negishi K, Tsubota K. Improvements in sleep quality and gait speed after cataract surgery. Rejuvenation Res 2013; 16 (01) 35-42
• 7 Lamoureux EL, Fenwick E, Pesudovs K, Tan D. The impact of cataract surgery on quality of life. Curr Opin Ophthalmol 2011; 22 (01) 19-27
• 8 Brown GC, Brown MM, Menezes A, Busbee BG, Lieske HB, Lieske PA. Cataract surgery cost utility revisited in 2012: a new economic paradigm. Ophthalmology 2013; 120 (12) 2367-2376
• 9 Henderson BA, Naveiras M, Butler N, Hertzmark E, Ferrufino-Ponce Z. Incidence and causes of ocular surgery cancellations in an ambulatory surgical center. J Cataract Refract Surg 2006; 32 (01) 95-102
• 10 Argo JL, Vick CC, Graham LA, Itani KM, Bishop MJ, Hawn MT. Elective surgical case cancellation in the Veterans Health Administration system: identifying areas for improvement. Am J Surg 2009; 198 (05) 600-606
• 11 Ament CS, Henderson BA. Optimizing resident education in cataract surgery. Curr Opin Ophthalmol 2011; 22 (01) 64-67
• 12 Martin KR, Burton RL. The phacoemulsification learning curve: per-operative complications in the first 3000 cases of an experienced surgeon. Eye (Lond) 2000; 14 (Pt 2): 190-195
• 13 Ng DT, Rowe NA, Francis IC. , et al. Intraoperative complications of 1000 phacoemulsification procedures: a prospective study. J Cataract Refract Surg 1998; 24 (10) 1390-1395