Indications and outcomes of resident-performed cataract surgery requiring return to the operating room

Schmidt, Caroline M.; Sundararajan, Miel; Biggerstaff, Kristin; Orengo-Nania, Silvia; Coffee, Robert E.; Khandelwal, Sumitra

doi:10.1016/j.jcrs.2015.11.043

Cited by 14 publications

(5 citation statements)

References 9 publications

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“…Numerous studies have sought to measure the learning curve in resident surgeries using parameters such as operative time, [4][5][6][7][8] intraoperative complications, [8][9][10][11][12][13][14] direct supervisor interventions, 9,10 visual outcomes, 8,14,15 and return to the operating room. 16,17 These studies demonstrated that increased surgeon experience corresponded to a decrease in these parameters. In a chart review of 680 cases, the adjusted phacoemulsification time and vitreous loss rate were significantly decreased when comparing the first 80 cataract surgeries of residents with the 81st to 207th surgeries.…”

Section: Introductionmentioning

confidence: 90%

<p>Operative Time and Complication Rates of Resident Phacoemulsification Surgeries in a National University Hospital: A Five-Year Review</p>

Umali¹,

Castillo²

2020

OPTH

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Purpose: To determine the operative time and complication rates of resident phacoemulsification surgeries at different time points in training. Methods: Retrospective cross-sectional study at the Department of Ophthalmology of the Philippine General Hospital. All resident-performed elective adult phacoemulsification surgeries from January 1, 2014, to December 31, 2018, were included, while operations with planned anterior or posterior procedures were excluded. Cases were arranged chronologically and divided into time points with 25 cases each. Operative time and complication rates were computed for each time point. As defined by the ICO Ophthalmology Surgical Competency Assessment Rubric (OSCAR), 30 minutes was used to gauge competency based on operative time, while complications were compared to published rates for residents. Results for the first 50 cases, the minimum number required by graduation, were also compared with succeeding cases. Results: A total of 4635 cases were included. Residents performed an average of 115.9 ± 30.4 cases, with no significant difference among residents (F(4,35)=2.64, p=0.12). Overall complication rate was 6% (n=276), similar to those reported internationally. Both median operative time and complication rates decreased significantly for every time point in training (p<0.001). After 50 cases, only 40% (n=16) of residents reached the operative time of 30 minutes. Median operative time is significantly lower when comparing the first 50 surgeries with the succeeding cases (37 minutes vs 29 minutes, p<0.001). Likewise, complication rate is also significantly lower (9.3% vs 3.5%, Χ 2 (1, N=4635) = 68.481, p<0.001), with an odds ratio of 2.85 (p<0.001, 95% CI [2.2, 3.7]). Conclusion: There are significant improvements in both operative time and complication rates as more surgeries are performed. However, the minimum required 50 cases is not enough for resident competency based on operative time and complication rates.

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Section: Introductionmentioning

confidence: 90%

<p>Operative Time and Complication Rates of Resident Phacoemulsification Surgeries in a National University Hospital: A Five-Year Review</p>

Umali¹,

Castillo²

2020

OPTH

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“…Also, to shorten case time, attendings should feel empowered step in or assist in parts of the procedure where the resident has stopped making adequate progress. It is interestingly worth noting, the mean resident operative time for cataract surgery reported in this study (34.1 min) is significantly shorter than times reported in resident cataract surgery literature (42.3-59.23 min) [ 14 , 15 ].…”

Section: Discussionmentioning

confidence: 50%

“…Furthermore, they studied cataracts by an attending or fellow surgeon, not a resident. Schmidt et al also showed an association with worse long term visual outcomes and operative time; however, these results were representative of only patients that required unplanned reoperation by resident surgeons, and not routine cataract surgery [ 14 ]. Again, there is no indication that phacoemulsification energy was controlled for.…”

Section: Discussionmentioning

confidence: 99%

Resident operative time as an independent predictor of early post-operative cataract surgery outcomes and supervising attending surgeon impact: a retrospective case series

Andrews,

Lin,

Lindsey

et al. 2024

BMC Ophthalmol

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Background The authors sought to determine if resident operative time in cataract extraction and intraocular lens insertion (CE/IOL) affects early visual outcomes and post-operative recovery. They further sought to investigate if attending surgeons can reduce resident operative time. Methods This retrospective, chart-review, case series at single Veterans Affairs Hospital (VA Tennessee Valley Healthcare System) studied resident cataract surgeries between March 1, 2018 and March 31, 2020. Following power analysis, 420 eyes of 400 patients from all resident cataract surgeries were included. Eyes with attending as primary surgeon, laser-assisted cataract surgery, or concurrent secondary procedures were excluded. Linear mixed effect models were used to study the association between operative time and visual outcomes while adjusting for covariates including cumulative dissipated energy, preoperative factors, and intraoperative complications. Results Longer operative time was statistically associated with worse post-operative-day 1 (POD1) pinhole visual acuity (PH-VA) adjusting for cumulative dissipated energy and other operative factors (p = 0.049). Although resident physicians were the primary surgeons, the operative times were different between the ten supervising attending surgeons in the study (p < 0.001). Conclusion The results suggest that increased resident operative time is a significant, independent risk factor for decreased POD1 PH-VA. Increased resident operative time is not associated with worsened long term visual outcomes. Attending surgeons may be able to reduce resident operative time, which is associated with improved early visual outcomes.

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“…Poorly dilated pupils were associated with increased complication rates both for residents and senior surgeons (9), whereas iris complications were likely to take more time from resident surgeons (10). Longer cataract surgery operation time predicted lower visual outcomes (11) or poorer patient satisfaction (12). Furthermore, PXF and the use of α1-blockers were associated with reduced post-operative visual acuity (13).…”

Section: Introductionmentioning

confidence: 99%

Cataract complications study: an analysis of adverse effects among 14,520 eyes in relation to surgical experience

Aaronson¹,

Kanclerz²,

Grzybowski³

et al. 2020

Ann Transl Med

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Indications and outcomes of resident-performed cataract surgery requiring return to the operating room

Abstract: Despite the need for reoperation within 30 days, most patients achieved improved visual acuity. The reoperation rate was significantly lower in the second half of the academic year. Increased operation times correlated with worse visual acuity independent of other variables.

Cited by 14 publications

References 9 publications

<p>Operative Time and Complication Rates of Resident Phacoemulsification Surgeries in a National University Hospital: A Five-Year Review</p>

<p>Operative Time and Complication Rates of Resident Phacoemulsification Surgeries in a National University Hospital: A Five-Year Review</p>

Resident operative time as an independent predictor of early post-operative cataract surgery outcomes and supervising attending surgeon impact: a retrospective case series

Cataract complications study: an analysis of adverse effects among 14,520 eyes in relation to surgical experience

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