Letter to the editor: immediate implications of improved surgical efficiency

Daniel Gologorsky,1 Timothy G Murray1,21Bascom Palmer Eye Institute, Anne Bates Leach Eye Hospital, University of Miami Miller School of Medicine, Miami, FL, USA; 2Murray Ocular Oncology and Retina, Miami, FL, USAEarlier this year we published our analysis regarding the improved surgical efficiencies that commenced with the transition from the Accurus (Alcon Surgical, Fort Worth, TX, USA) to the Constellation Vision System (Alcon Surgical) integrated vitrectomy platform.1 The results of our study demonstrated that the transition to the Constellation platform resulted in an increase in the number of patient operations per day (from 7.55 to 8.53, a 12.98% increase), with a concurrent and statistically significant decrease in surgical room time (occurring without compromise to patient evaluated outcomes). The ramifications of such changes on resource allocation and operations management have not been reported. This brief report will expound on the immediate implications of increased surgical efficiency.View original paper by Murray and colleagues

Retrospective analysis of patients self-referred to comprehensive ophthalmology seeking second opinions

Daniel Gologorsky1, Scott H Greenstein2 1Dartmouth Medical School, Hanover, NH, USA; 2Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA Abstract: Patients choose to seek a second opinion in matters related to their health for a variety of reasons, and the total cost associated with these second opinion visits is estimated to be billions of dollars annually. Understanding the reasons behind second opinion self-referrals is key to improving patient satisfaction and reducing redundancy in delivered health care. This study represents a retrospective analysis of the records from a single provider at the Massachusetts Eye and Ear Infirmary (MEEI) Comprehensive Ophthalmology Service in order to determine the various reasons that patients self-refer to an ophthalmology clinic seeking second opinions. A total of 174 patients presenting for a second opinion were identified over a one-year period. Patients presented for second opinions for two primary reasons: 60% presented in order to seek a confirmation of a diagnosis from an outside ophthalmologist (54%) or optometrist (6%), and 40% presented due to a previous adverse experience with an outside provider, such as perceived treatment failure (26%), poor bedside manner (3%), distrust of the provider (5%), and poor provider communication skills (7%). This study strives to reiterate that the reduction of adverse patient experiences through effective communication of expected treatment options and outcomes, with a realistic time course of therapy, could significantly improve patient satisfaction and reduce costly second opinion visits. Keywords: referral, self-referral, second opinion, comprehensive ophthalmolog

Cataract surgery in the setting of severe pathologic myopia with high axial length: use of pars plana lensectomy and vitrectomy

Daniel Gologorsky, Harry W Flynn Jr Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA Abstract: Cataract surgery in patients with pathologic myopia and high axial length can be challenging for a variety of reasons, including imprecise intraocular lens calculations in eyes with posterior staphylomas and intraoperative complications such as suprachoroidal hemorrhage, posterior capsular rupture, and retinal tears. Although most surgeons recommend standard phacoemulsification and preservation of the posterior capsule in these cases, an alternative approach presented in this series entails the removal of the lens through the pars plana and removal of formed vitreous during the concurrent procedure. Keywords: cataract surgery, pathologic myopia, high axial length, aphaki

Factors Associated with Mortality Within 24h of Liver Transplantation: An Updated Analysis of 65,308 Adult Liver Transplant Recipients Between 2002 and 2013

STUDY OBJECTIVES: Intracardiac and pulmonary thromboembolism (ICPTE), its risk factors and contribution to 24-hour mortality after adult liver transplantation for end-stage liver disease. DESIGN: Retrospective analysis of Standard Transplant Analysis and Research electronic database files. SETTING: Perioperative. PATIENTS: Electronic files of 65,308 adult liver transplant recipients between 2002 and 2013 obtained from Organ Procurement and Transplantation Network. INTERVENTIONS: Mortality cause analysis and design of a multivariable logistic regression model for predicting the risk of 24-hour mortality due to devastating ICPTE. MEASUREMENTS: Perioperative mortality, donor and recipient demographics, donor cause of death, graft ischemic times, etiologies of recipient end-stage liver disease, functional status, comorbidities, and laboratory values. MAIN RESULTS: 41,324 patients were included. 38,293 (92.6%) survived 30 days after transplantation. Postoperative 24-hour mortality was 547 (1.3%) and 2484 (6.0%) within subsequent 30days. Uncontrolled hemorrhage (57 patients, 0.14%), devastating ICPTE (54 patients, 0.13%) and primary graft failure (49 patients, 0.12%) contributed the most and equally to the 24-hour mortality. For the ICPTE, recipients\u27 prior history of pulmonary embolism, portal vein thrombosis, functional status (Karnofsky score