Cost analysis of immediate versus delayed bilateral cataract surgery in seniors in community-based ambulatory surgical centers in a post-COVID-19 era

OBJECTIVE: To evaluate the cost-savings of immediately sequential bilateral cataract surgery versus delayed sequential bilateral cataract surgery among seniors at a Canadian community-based ambulatory surgical center in the post-COVID-19 era. DESIGN: Prospective chart review. PARTICIPANTS: Seniors aged 60 and older undergoing cataract extraction surgery at a community-based ambulatory surgical center in Ontario. METHODS: Direct and indirect cost metrics were collected from 202 patients who underwent either delayed sequential bilateral cataract surgery (DSBCS) or immediately sequential bilateral cataract surgery (ISBCS) at 1 of 2 community-based ambulatory surgical center (ASCs) between January 2022 and January 2023. Direct cost measures included preoperative, intraoperative, and postoperative surgical expenses. Preoperative measures included diagnostic and consultation fees. Intraoperative metrics consisted of medical and nonmedical labor, anesthesia fees, and consumables (including amortized cost of equipment and sterilization). Postoperative surgical costs included the first postoperative follow-up visit and a postoperative visit at week 1 (POW1). Indirect costs were measured by the cost of travel and additional postoperative visits (any visits other than required for the first postoperative visit and POW1). Additional economic factors included total time spent travelling and total duration of travel. RESULTS: The average costs were reduced by $375.22 CAD when performing ISBCS (p < 0.001), totaling to $1260.33 versus DSCBS's total cost of $1635.55. Specifically, direct surgical costs were $1487.95 for DSBCS and $1176.93 for ISBCS (p < 0.001), whereas indirect costs were $147.60 for DSBCS versus $83.40 for ISBCS (p < 0.001). CONCLUSIONS: The average costs of cataract extraction among senior patients in ambulatory surgical centers were significantly lower for ISBCS compared to DSBCS.