Ophthalmology Residents' Experience in Cataract Surgery: Preoperative Risk Factors, Intraoperative Complications, and Surgical Outcomes.
Cataract
Complications
Experience
Residents
Risk factors
Score
Journal
Ophthalmology and therapy
ISSN: 2193-8245
Titre abrégé: Ophthalmol Ther
Pays: England
ID NLM: 101634502
Informations de publication
Date de publication:
02 May 2024
02 May 2024
Historique:
received:
23
02
2024
accepted:
26
03
2024
medline:
2
5
2024
pubmed:
2
5
2024
entrez:
2
5
2024
Statut:
aheadofprint
Résumé
This retrospective study explores the connection between preoperative patient risk factors, the experience of ophthalmology residents, and the outcomes of cataract surgeries performed at Hadassah Medical Center. It is hypothesized that with increased experience, residents may demonstrate greater proficiency in handling surgeries on higher-risk patients, potentially leading to improved surgical outcomes overall. Data were examined from 691 consecutive cataract surgeries in 590 patients, conducted by ophthalmology residents at Hadassah Medical Center (January 2018 to February 2022). Demographics, surgeon experience, preoperative cataract risk assessment score, and pre- and postoperative corrected distance visual acuity (CDVA) were analyzed. The risk score was based on cataract density, previous vitrectomy, presence of phacodonesis, small pupil, extreme axial length (> 30 mm or < 21.5 mm) or abnormal axial length (26-30 mm), shallow anterior chamber (< 2.5 mm), poor patient cooperation, oral alpha-1 blocker use, diabetic retinopathy (DR), Fuchs endothelial dystrophy, and having one functioning eye. This study focused on the correlation of risk scores with residents' surgical experience and surgical outcomes. As residents gained experience, surgeries on patients with at least one risk factor increased from 54% (first year) to 75% (second year; p < 0.001) and fluctuated between 75%, 82%, and 77% (third, fourth, and fifth years, respectively), with initial preoperative CDVA declining progressively. Despite handling more complex cases over time, the percentage of intraoperative complications per patient decreased with each year of residents' experience (17%, 13%, 11%, 17%, 6%; respectively). Patients without any risk factor had higher postoperative CDVA than those with one or more risk factors (mean ± standard deviation [SD] in logMAR, 0.16 ± 0.26 vs. 0.27 ± 0.35; p < 0.001) and a higher percentage of CDVA improvement (63% vs. 57%, p = 0.016). The use of a preoperative risk assessment scoring system to allocate surgeries to residents at varying experience levels may reduce the risk for surgical complications, thereby ensuring patient safety and providing residents with a gradual learning experience.
Identifiants
pubmed: 38696047
doi: 10.1007/s40123-024-00947-6
pii: 10.1007/s40123-024-00947-6
doi:
Types de publication
Journal Article
Langues
eng
Informations de copyright
© 2024. The Author(s).
Références
Rossi T, et al. Original research: cataract surgery practice patterns worldwide: a survey. BMJ Open Ophthalmol. 2021;6:e000464.
doi: 10.1136/bmjophth-2020-000464
pubmed: 33501377
pmcid: 7812090
Kauh CY, Blachley TS, Lichter PR, Lee PP, Stein JD. Geographic variation in the rate and timing of cataract surgery among US communities. JAMA Ophthalmol. 2016;134:267–76.
doi: 10.1001/jamaophthalmol.2015.5322
pubmed: 26720865
pmcid: 5767078
Gower EW, et al. Perioperative antibiotics for prevention of acute endophthalmitis after cataract surgery. Cochrane Database Syst Rev. 2017;2:214.
Raczyńska D, Glasner L, Serkies-Minuth E, Wujtewicz MA, Mitrosz K. Eye surgery in the elderly. Clin Interv Aging. 2016;11:407–17.
doi: 10.2147/CIA.S101835
pubmed: 27103794
pmcid: 4827591
Payal AR, et al. Outcomes of cataract surgery with residents as primary surgeons in the Veterans Affairs Healthcare System. J Cataract Refract Surg. 2016;42:370–84.
doi: 10.1016/j.jcrs.2015.11.041
pubmed: 27063517
Aaronson A, Viljanen A, Kanclerz P, Grzybowski A, Tuuminen R. Cataract complications study: an analysis of adverse effects among 14,520 eyes in relation to surgical experience. Ann Transl Med. 2020;8:1541–1541.
doi: 10.21037/atm-20-845
pubmed: 33313286
pmcid: 7729371
Ellis EM, et al. Complication rates of resident-performed cataract surgery: impact of early introduction of cataract surgery training. J Cataract Refract Surg. 2018;44:1109.
doi: 10.1016/j.jcrs.2018.06.022
pubmed: 30078539
pmcid: 6157597
Rutar T, Porco TC, Naseri A. Risk factors for intraoperative complications in resident-performed phacoemulsification surgery. Ophthalmology. 2009;116:431–6.
doi: 10.1016/j.ophtha.2008.10.028
pubmed: 19167084
Zaidi FH, Corbett MC, Burton BJL, Bloom PA. Raising the benchmark for the 21st century—the 1000 cataract operations audit and survey: Outcomes, Consultant-supervised training and sourcing NHS choice. Br J Ophthalmol. 2007;91:731–6.
doi: 10.1136/bjo.2006.104216
pubmed: 17050577
Randleman JB, et al. The resident surgeon phacoemulsification learning curve. Arch Ophthalmol. 2007;125:1215–9.
doi: 10.1001/archopht.125.9.1215
pubmed: 17846361
Lee JS, Hou CH, Yang ML, Kuo JZC, Lin KK. A different approach to assess resident phacoemulsification learning curve: analysis of both completion and complication rates. Eye (Lond). 2009;23:683–7.
doi: 10.1038/sj.eye.6703103
pubmed: 18239676
Han JV, et al. Auckland cataract study III: refining preoperative assessment with cataract risk stratification to reduce intraoperative complications. Am J Ophthalmol. 2019;197:114–20.
doi: 10.1016/j.ajo.2018.09.026
pubmed: 30278159
Mangan MS, Atalay E, Arici C, Tuncer İ, Bilgeç MD. Comparison of different types of complications in the phacoemulsification surgery learning curve according to number of operations performed. Turk J Ophthalmol. 2016;46:7.
doi: 10.4274/tjo.83788
pubmed: 27800250
pmcid: 5076311
Kaplowitz K, Yazdanie M, Abazari A. A review of teaching methods and outcomes of resident phacoemulsification. Surv Ophthalmol. 2018;63:257–67.
doi: 10.1016/j.survophthal.2017.09.006
pubmed: 28941765
Allinson RW, Metrikin DC, Fante RG. Incidence of vitreous loss among third-year residents performing phacoemulsification. Ophthalmology. 1992;99:726–30.
doi: 10.1016/S0161-6420(92)31904-9
pubmed: 1594218
Corey RP, Olson RJ. Surgical outcomes of cataract extractions performed by residents using phacoemulsification. J Cataract Refract Surg. 1998;24:66–72.
doi: 10.1016/S0886-3350(98)80076-X
pubmed: 9494901
Al-Jindan M, et al. Assessment of learning curve in phacoemulsification surgery among the Eastern Province ophthalmology program residents. Clin Ophthalmol. 2020;14:113.
doi: 10.2147/OPTH.S241250
pubmed: 32021075
pmcid: 6969689
Woodfield AS, Gower EW, Cassard SD, Ramanthan S. Intraoperative phacoemulsification complication rates of second- and third-year ophthalmology residents: a 5-year comparison. Ophthalmology. 2011;118:954–8.
doi: 10.1016/j.ophtha.2010.08.047
pubmed: 21539981
Magyar M, Sandor GL, Ujvary L, Nagy ZZ, Toth G. Intraoperative complication rates in cataract surgery performed by resident trainees and staff surgeons in a tertiary eyecare center in Hungary. Int J Ophthalmol. 2022;15:586.
doi: 10.18240/ijo.2022.04.10
pubmed: 35450176
pmcid: 8995720
Low SAW, Braga-Mele R, Yan DB, El-Defrawy S. Intraoperative complication rates in cataract surgery performed by ophthalmology resident trainees compared to staff surgeons in a Canadian academic center. J Cataract Refract Surg. 2018;44:1344–9.
doi: 10.1016/j.jcrs.2018.07.028
pubmed: 30201127
Oliveira-Ferreira C, Leuzinger-Dias M, Tavares-Ferreira J, Macedo JP, Falcão-Reis F. Cataract phacoemulsification performed by resident trainees and staff surgeons: intraoperative complications and early postoperative intraocular pressure elevation. J Cataract Refract Surg. 2020;46:555–61.
doi: 10.1097/j.jcrs.0000000000000105
pubmed: 32271522
Fong CSU, et al. Long-term outcomes of phacoemulsification cataract surgery performed by trainees and consultants in an Australian cohort. Clin Exp Ophthalmol. 2012;40:597–603.
doi: 10.1111/j.1442-9071.2012.02759.x
pubmed: 22300362
Kim BZ, Patel DV, Sherwin T, McGhee CNJ. The Auckland cataract study: assessing preoperative risk stratification systems for phacoemulsification surgery in a teaching Hospital. Am J Ophthalmol. 2016;171:145–50.
doi: 10.1016/j.ajo.2016.09.003
pubmed: 27637785
Drivers License Levels|Israeli Ministry of Transport and Road Safety. 2023. https://www.gov.il/he/departments/guides/driving_licence_categories .
Virtanen P, et al. SciPy 1.0: fundamental algorithms for scientific computing in Python. Nat Methods. 2020;17:261–72.
doi: 10.1038/s41592-019-0686-2
pubmed: 32015543
pmcid: 7056644
Burton MJ, et al. The Lancet Global Health Commission on Global Eye Health: vision beyond 2020. Lancet Glob Health. 2021;9:e489–551.
doi: 10.1016/S2214-109X(20)30488-5
pubmed: 33607016
pmcid: 7966694
Hatch WV, Campbell EDL, Bell CM, El-Defrawy SR, Campbell RJ. Projecting the growth of cataract surgery during the next 25 years. Arch Ophthalmol. 2012;130:1479–81.
doi: 10.1001/archophthalmol.2012.838
pubmed: 23143457
Butler TKH. Risk stratification and assessment in cataract surgery. J Cataract Refract Surg. 2012;38:184.
doi: 10.1016/j.jcrs.2011.10.022
pubmed: 22153107
Narendran N, et al. The Cataract National Dataset electronic multicentre audit of 55 567 operations: risk stratification for posterior capsule rupture and vitreous loss. Eye. 2009;23:31–7.
doi: 10.1038/sj.eye.6703049
pubmed: 18327164
Muhtaseb M, Kalhoro A, Ionides A. A system for preoperative stratification of cataract patients according to risk of intraoperative complications: a prospective analysis of 1441 cases. Br J Ophthalmol. 2004;88:1242–6.
doi: 10.1136/bjo.2004.046003
pubmed: 15377542
pmcid: 1772356
Shingleton BJ, Crandall AS, Ahmed IIK. Pseudoexfoliation and the cataract surgeon: preoperative, intraoperative, and postoperative issues related to intraocular pressure, cataract, and intraocular lenses. J Cataract Refract Surg. 2009;35:1101–20.
doi: 10.1016/j.jcrs.2009.03.011
pubmed: 19465298
Ong AY, Shalchi Z. Outcomes of cataract surgery in pseudoexfoliation syndrome in England: 10-year retrospective cohort study. J Cataract Refract Surg. 2021;47:165–71.
doi: 10.1097/j.jcrs.0000000000000397
pubmed: 32826704
Briszi A, Prahs P, Hillenkamp J, Helbig H, Herrmann W. Complication rate and risk factors for intraoperative complications in resident-performed phacoemulsification surgery. Graefe’s Arch Clin Exp Ophthalmol. 2012;250:1315–20.
doi: 10.1007/s00417-012-2003-y
Umali MIN, Castillo TR. Operative time and complication rates of resident phacoemulsification surgeries in a national university hospital: a five-year review. Clin Ophthalmol. 2020;14:4065.
doi: 10.2147/OPTH.S283754
pubmed: 33262571
pmcid: 7699982
Melega MV, et al. Comparing resident outcomes in cataract surgery at different levels of experience. Clin Ophthalmol. 2020;14:4523.
doi: 10.2147/OPTH.S285967
pubmed: 33402815
pmcid: 7778434
Han JV, et al. Auckland Cataract Study IV: Practical application of NZCRS cataract risk stratification to reduce phacoemulsification complications. Clin Exp Ophthalmol. 2020;48:311–8.
doi: 10.1111/ceo.13696
pubmed: 31804765
Jaycock P, et al. The Cataract National Dataset electronic multi-centre audit of 55 567 operations: updating benchmark standards of care in the United Kingdom and internationally. Eye. 2009;23:38–49.
doi: 10.1038/sj.eye.6703015
pubmed: 18034196
Lee JS, Hou CH, Lin KK. Surgical results of phacoemulsification performed by residents: a time-trend analysis in a teaching hospital from 2005 to 2021. J Ophthalmol. 2022;2022:1.
Riley AF, et al. The Auckland cataract study: co-morbidity, surgical techniques, and clinical outcomes a public hospital service. Br J Ophthalmol. 2002;86:185–90.
doi: 10.1136/bjo.86.2.185
pubmed: 11815345
pmcid: 1770992
Kim BZ, Patel DV, McGhee CNJ. Auckland cataract study 2: clinical outcomes of phacoemulsification cataract surgery in a public teaching hospital. Clin Exp Ophthalmol. 2017;45:584–91.
doi: 10.1111/ceo.12922
pubmed: 28168827