Article Text

Download PDFPDF
Evaluation of a hub-and-spoke model for the delivery of femtosecond laser-assisted cataract surgery within the context of a large randomised controlled trial
  1. Harry W Roberts1,2,
  2. Vijay K Wagh1,
  3. Isabella J M Mullens1,
  4. Simone Borsci3,
  5. Melody Z Ni3,
  6. David P S O’Brart1,2
  1. 1 Department of Ophthalmology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
  2. 2 King’s College London, London, UK
  3. 3 Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
  1. Correspondence to Mr Harry W Roberts, Department of Ophthalmology, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK; harry.roberts{at}


Aims To test a hypothesis that cataract operating room (OR) productivity can be improved with a femtosecond laser (FL) using a hub-and-spoke model and whether any increase in productivity can offset additional costs relating to the FL.

Methods 400 eyes of 400 patients were enrolled in a randomised-controlled trial comparing FL-assisted cataract surgery (FLACS) with conventional phacoemulsification surgery (CPS). 299 of 400 operations were performed on designated high-volume theatre lists (FLACS=134, CPS=165), where a hub-and-spoke FLACS model (1×FL, 2×ORs=2:1) was compared with independent CPS theatre lists. Details of operative timings and OR utilisation were recorded. Differences in productivity between hub-and-spoke FLACS and CPS sessions were compared using an economic model including testing hypothetical 3:1 and 4:1 models.

Results The duration of the operation itself was 12.04±4.89 min for FLACS compared with CPS of 14.54±6.1 min (P<0.001). Total patient time in the OR was reduced from 23.39±6.89 min with CPS to 20.34±5.82 min with FLACS (P<0.001)(reduction of 3.05 min per case). There was no difference in OR turnaround time between the models. Average number of patients treated per theatre list was 9 for FLACS and 8 for CPS. OR utilisation was 92.08% for FLACS and 95.83% for CPS (P<0.001). Using a previously established economic model, the FLACS service cost £144.60 more than CPS per case. This difference would be £131 and £125 for 3:1 and 4:1 models, respectively.

Conclusion The FLACS hub-and-spoke model was significantly faster than CPS, with patients spending less time in the OR. This enabled an improvement in productivity, but insufficient to meaningfully offset the additional costs relating to FLACS.

  • clinical trial
  • treatment lasers
  • treatment surgery

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors HR, VW, IM and DPSOB contributed to acquisition of data, analysis and interpretation of data. HWR, MZN and SB contributed to analysis of data, all authors contributed to drafting the article and revising it critically for important intellectual content.

  • Funding This research has been supported by a non-commercial research grant from Alcon Incorporated (Grant number: IIT #17440075) and by the NIHR Diagnostic Evidence Co-operative London. The funding organisation had no role in the design or conduct of this research.

  • Disclaimer The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests DPSOB has undertaken consultancy work for Sooft Italia SPA and Alcon in the past 12 months. No other conflicting relationship exists for any author.

  • Ethics approval The study was approved by local Research & Development and Cambridge South Research Ethics Committee (reference 16/EE/0180).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data available on request.

  • Correction notice This article has been corrected since it was published Online First. The research grant from Alcon Incorporated has been added into the Funding statement.

Linked Articles

  • At a glance
    Keith Barton James Chodosh Jost B Jonas