Determinants of cataract surgical opportunities and complication rates in UK higher specialist training

Abstract

Purpose The volume of cataract surgery performed by trainee ophthalmologists in the UK, and the complication rates experienced by those trainees is unknown. As a result, no appropriate audit benchmark exists for trainees or their trainers. This study describes the surgical opportunities and rates of posterior capsule rupture (PCR) experienced by higher specialist trainees in one UK training region and explores influencing factors. Methods Number of cataract operations and episodes of PCR in each calendar month were recorded from surgical logbooks for all Specialist Registrars (SpRs) who had completed at least 6 months of training by January 2007. Dates and details of the posts in which the surgery was performed were also recorded. Results Data from 475 completed months were collected from 19 trainees including 4322 cataract operations and 99 episodes of PCR. Trainees performed a mean 9.1 operations per month. This varied significantly between different subspeciality posts; the fewest cataracts were on paediatric and oculo-plastic firms. District General Hospitals offered more surgery than Teaching Hospitals; mean 10.9 vs 8.5 cataracts per month (P ¼ 0.005). No difference in surgical opportunity was found between male and female trainees. An overall PCR rate of 2.3% (95% CI 2.25-2.33%) was found, which decreased significantly with increasing experience (Po0.01). Conclusion SpRs in Yorkshire expect to complete around 500 cataract operations in their 4.5 years of training. A PCR rate of 2.3% was found for trainees with a mean of 25 months higher specialist training which compares favourably with published series of trainees from other countries.

The Cataract National Dataset Electronic Multi-centre Audit of 55 567 Operations: variation in posterior capsule rupture rates between surgeons

“…The overall rate of 2.48% for senior trainees (specialist registrars and fellows) in this study was comparable with that reported in a recent study that analysed UK trainees log books 19 (mean 2.29%, range 0.6-6.9%). The upper end of this range may appear alarming, but with small sample sizes these variations in rates may well be due to sampling error, an effect which is well illustrated by our funnel plots.…”

“…These data contrast with previous studies, which only presented figures for overall PCR rates without any measures of variation between surgeons, 6,8,9 with the exception of a few small studies that focused on trainees alone. 19 Our previous report 9 has demonstrated that the data collected are likely to be typical of all cataract surgery in the United Kingdom, as the basic demographic data on age, sex, and frequency of day case are similar to the National Hospital Episode Statistics during the same time period. 21 As expected, the study demonstrates that the rate of PCR is much lower for independent surgeons (consultants, staff grades, and associate specialists, Figure 2) than it is for senior trainees (specialist registrars and fellows, Figure 3) and the most junior trainee surgeons (SHOs, Figure 4).…”

“…16 Many large studies have documented mean rates of PCR in cohorts of patients, 6,8,9,14 or learning curves for trainees 17 or experienced surgeons learning phacoemulsification. 18 Very few studies, however, have analysed inter-surgeon variation of this benchmark complication and all such studies involved junior surgeons 19 during training rather than fully trained surgeons who deliver the majority of cataract surgery in the NHS. 9 The primary aim of this audit is to describe the overall rates and variations of PCR within each grade of surgeon in the United Kingdom using a large data set extracted as part of the piloting of the CND.…”

Cataract skills: how do we judge competency?

“…1 UK trainees' logbook reviews demonstrate significant decreases in complication rates with increasing experience. 6 One review of 680 trainee operations over four years saw vitreous loss rate halved from 5.1% to 1.9% after the first 80 cases, correlating with significant falls in mean phacoemulsification time. 7…”

“…1 UK trainees' logbook reviews demonstrate significant decreases in complication rates with increasing experience. 6 One review of 680 trainee operations over four years saw vitreous loss rate halved from 5.1% to 1.9% after the first 80 cases, correlating with significant falls in mean phacoemulsification time. 7 While this indicates '80' as a possible minimum, trainees' efficiency continues improving well beyond this, 7 and complications keep falling after the first 200 cases.…”