Patients’ subjective assessment of the duration of cataract surgery: a case series

Objectives: Surgery duration is a source of preoperative anxiety for patients undergoing cataract surgery. To better inform patients, we evaluated the agreement between objective and patient-perceived surgery durations. Design: Case series. Setting: Public teaching university hospital (Paris, France). Participants: During the study period, 368 cataract surgery cases performed on 285 patients were included, 85 cases were excluded from the final analysis. All patients who had uneventful phacoemulsification were included. Cases with any significant intraoperative adverse event or cases requiring additional anaesthesia other than topical were excluded. Resident performed cases were also excluded. Primary and secondary outcomes: Procedures were timed (objective duration) and patients were asked, immediately afterwards, to assess the duration of their surgery (patient-assessed duration). The agreement between objective and patient-assessed durations as well as influencing factors was studied. Results: Mean objective duration (13.9±5 min) and patient-assessed duration (15.3±6.9 min) were significantly correlated (Spearman's r=0.452, p<0.0001). Furthermore, Bland-Altman analysis and the intraclass correlation coefficient (0.341, 95% CI 0.23 to 0.44) were quite in agreement. On univariate analysis, senior-performed procedures were significantly shorter than those performed by juniors (13.4 vs 17.8 min, p=0.0001). Pain was recorded as ‘no sensation’ (31.5% of the cases), ‘mild sensation’ (41%), ‘moderate pain’ (23.3%), ‘intense pain’ (3.5%) and ‘unbearable pain’ (0.7%). Groups with high pain score had significantly longer procedures (p<0.001). Multivariate analysis revealed that the only independent factors associated with both the objective and patient-assessed durations of surgery were surgeon's experience and pain-score. Conclusions: In our study, patients’ estimated and real duration of the surgery showed moderate agreement, suggesting that emotions associated with eye surgery under topical anaesthesia did not dramatically hinder the patients’ perception of time. However, the benefit of preoperative counselling regarding the duration of surgery will need further evaluation.

研究目标：手术时长是接受白内障手术患者术前焦虑的重要诱因之一。为向患者提供更充分的术前知情告知，本研究评估了客观测量的手术时长与患者主观感知的手术时长之间的一致性。
研究设计：病例系列研究（Case series）。
研究地点：法国巴黎公立教学大学附属医院。
研究对象：研究期间共纳入285名患者的368例白内障手术病例，最终分析排除85例。本研究纳入所有接受顺利超声乳化白内障吸除术（phacoemulsification）的患者；排除术中出现任何显著不良事件、需采用表面麻醉以外的额外麻醉方式，以及由住院医师主刀的手术病例。
主要与次要结局指标：研究人员记录手术的客观时长，并于术后即刻询问患者，让其自行评估手术时长。本研究旨在分析客观手术时长与患者主观评估时长之间的一致性及其影响因素。
研究结果：客观测量的平均手术时长为(13.9±5)分钟，患者主观评估的平均手术时长为(15.3±6.9)分钟，二者存在显著相关性（斯皮尔曼秩相关系数Spearman's r=0.452，p<0.0001）。此外，Bland-Altman分析法（Bland-Altman analysis）与组内相关系数（intraclass correlation coefficient=0.341，95%CI 0.23~0.44）的分析结果均显示二者具有较好的一致性。单因素分析结果显示，高年资医师主刀的手术时长显著短于低年资医师（13.4 min vs 17.8 min，p=0.0001）。本研究中疼痛程度分为以下等级：无不适感（31.5%）、轻微不适（41%）、中度疼痛（23.3%）、剧烈疼痛（3.5%）以及难以忍受的疼痛（0.7%）；疼痛评分较高的组别手术时长显著更长（p<0.001）。多因素分析结果显示，仅术者经验与疼痛评分是与客观手术时长及患者主观感知时长均相关的独立影响因素。
研究结论：本研究中，患者对手术时长的估算值与实际时长仅存在中等程度的一致性，提示表面麻醉下眼科手术相关的情绪反应并未显著干扰患者对时间的感知。不过，术前针对手术时长的健康宣教的临床获益仍需进一步研究评估。