Risk Factors for Return to the Operating Room after Resident-Performed Cataract Surgery

Menda, Shivali; Driver, Todd H.; Neiman, Alexandra E.; Blumberg, Seth; Naseri, Ayman; Stewart, Jay M.

doi:10.1080/08820538.2016.1208760

Cited by 8 publications

(8 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: 91%

<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: 91%

<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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“…By doing clinical audit we calculate some important facts that are usually missed like steps of surgery, instruments used and time taken. [18][19][20][21] So, for the betterment of surgical outcomes, audit and re audit should be conducted. [22][23][24][25] Postoperative VA was recorded for 982 (100%) eyes.…”

Section: Discussionmentioning

confidence: 99%

Visual outcome of cataract surgery in a tertiary care teaching hospital

Junejo

Murtaza²,

Shaikh³

et al. 2022

Pak J Med Sci

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Objectives: To review the visual outcomes after cataract surgery in a tertiary care teaching hospital, Isra University Hyderabad. Methods: This retrospective clinical study was carried out for six months at Isra University Hyderabad from December 2020-May 2021. Total patients included were 982. The data comprised of patients who underwent cataract surgery from Sept 2018 – Aug 2020. Individuals over 40 years were included and who returned for out-patient appointments. Visual acuity before and six weeks after cataract surgery were noted and categorized according to World Health Organization criteria (i-e Good, Moderate and Poor).. Data analysis was done with the help of SPSS version 22.0. Results: Out of 982 patients who underwent Phacoemulsification at Isra University Hospital, the operated eyes were 483 right and 499 left respectively. Meanwhile, 966 had good visual acuity six weeks after the surgery, while 16 had moderate visual acuity noted after six weeks. Conclusion: Clinical audit of cataract surgeries by measuring visual acuity postoperatively is an excellent approach in improving the outcomes and maintaining the good care facilities at a tertiary care hospital. doi: https://doi.org/10.12669/pjms.38.4.5163 How to cite this:Junejo MS, Rebecca, Shaikh FF, Siyal N. Visual outcome of cataract surgery in a tertiary care teaching hospital. Pak J Med Sci. 2022;38(4):---------. doi: https://doi.org/10.12669/pjms.38.4.5163 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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“…Surgical trainingincluding length of training-predicts performance and outcomes, though not necessarily transferability, across subspecialties. [28][29][30][31][32][33][34] Limitations of this study include the small number of residents assessed (n ¼ 12) and differences in oculoplastic training. Early in the years of this retrospective chart review, residents did not have an immersive oculoplastic training period.…”

Section: Discussionmentioning

confidence: 99%

Evaluating Resident Training in Oculoplastic Surgery: A Case Series of 104 Eviscerations

2018

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Purpose The aim of this study is to evaluate resident surgical performance based on complications after ocular evisceration. Methods A retrospective chart review of eviscerations performed between October 2011 and May 2017 by ophthalmology residents as the primary or assistant surgeon under the guidance of a single oculofacial plastic surgeon (M.O.G.) was completed. Data collected included reason for evisceration, resident participation in the case and resident's month of oculoplastic training, surgical technique, subsequent complications, and duration of follow-up. Results There were no significant differences in complication rates or surgical sequelae in resident-led versus attending-led surgeries. The complication rate for all cases in total was 5.77%. A slight negative correlation existed between the resident's month of training and the presence of postoperative complications. The number of adverse events was found to be significantly correlated with the duration of patient follow-up. Discussion Ocular eviscerations performed by ophthalmology residents as primary surgeons achieve outcomes equivalent to published reports, suggesting ocular eviscerations are a safe, effective procedure wherein residents can refine surgical skills. Some surgical sequelae may be linked to particular surgeons, implying evisceration outcomes can be used to assess resident surgical performance. Fewer adverse events arose as the resident's length of oculoplastic training increased, but this finding did not reach significance. Larger studies are needed to explore these trends.

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Risk Factors for Return to the Operating Room after Resident-Performed Cataract Surgery

Abstract: Phacoemulsification done by a junior resident or using the divide-and-conquer technique had the highest risk of reoperation.

Cited by 8 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>

Visual outcome of cataract surgery in a tertiary care teaching hospital

Evaluating Resident Training in Oculoplastic Surgery: A Case Series of 104 Eviscerations

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