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Nataliya Pokeza, Arun Joseph, Nessy Dehan, Kichiemon Asoma; Variations in intraoperative complication rates for resident performed cataract surgery during an academic year. Invest. Ophthalmol. Vis. Sci. 2017;58(8):767.
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Cataract surgery training is an integral aspect of resident education in ophthalmology. Graduates are expected to demonstrate the ability to competently and independently perform cataract surgery. Studies have shown that cataract complication rates decrease with increasing operative volume for resident cataract surgery. In this retrospective study, we want to determine the rate of intraoperative surgical complications for resident performed cataract surgery over the course of an academic year in our institution as it could potentially impact resident surgical education in ophthalmology.
This was a retrospective review of 2580 patient charts who underwent cataract surgery at Kings County Hospital Center, Brooklyn, NY from Feb 1, 2007, through Aug 31, 2011. Assessment of intraoperative complications such as posterior capsule tears, vitreous loss and loss of the nucleus was determined by reviewing surgical logbooks and operative notes in the Quadramed electronic medical record. For each patient who had an intraoperative complication, the date of surgery and type of complication was recorded. Patients under the age eighteen, patients who had non-phacoemulsification cataract extraction or who underwent combined surgical procedures were excluded.
New resident cataract surgeons started at about 20% rate of cataract surgery complication in July. Complication rates decreased to about 10% in the two subsequent months. The rate of complications rose in November-December and then subsequently fell to just under 10% in April and May (Fig. 1).
As expected, resident complication rates were highest at the beginning of an academic year. Interestingly, the rate increased in the middle of an academic year that we hypothesize may be due to attending physicians giving residents more autonomy. Overestimation of resident’s own abilities or weakening vigilance could also account for the observed pattern. As residents become more proficient later in an academic year, complication rates steadily declined, although not as much as we expected. This can likely be attributed to residents taking on more challenging cases in the latter portion of their training.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
Fig 1. Intraoperative complication rates for resident performed cataract surgery during an academic year
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