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Parisa Taravati, Divakar Gupta, Leona Ding; Does case order affect cataract surgery complication rates and case time?. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1839.
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Cataract surgery is typically performed by the same surgeon multiple times in a single day. Complications occur at low rates but can result in significant morbidity for the patient. Recently, it has been reported that preoperative “warm-up” exercises for surgeons in other specialties may decrease surgical complication rates and operating time. The purpose of this study is to determine if cataract surgical case order affects the complication rate and case time.
We performed a retrospective, consecutive review of patients who underwent cataract extraction by phacoemulsification at the University of Washington Medicine Eye Institute at Harborview from June 2010 to December 2011. We evaluated case order for each surgeon, comparing complication rates and case times for attending and resident surgeons for their first case of the day versus subsequent cases. There was no formal “warm-up” before the first case. We included both straightforward and complex phacoemulsification surgeries, such as those with white cataracts and floppy iris syndrome. We excluded patients who had phacoemulsification combined with another surgery.
We reviewed a total of 1153 cases. The complication rate for all surgeons (residents and attendings) was 4.2%, and as expected, was statistically different between residents and attendings (10.4% and 2.7%, respectively, p<0.0001). However, there was not a statistically significant difference in complication rates between the first case and subsequent cases in the day, and this held true for both residents and attendings (p=0.452). Not surprisingly, case time was significantly longer in resident versus attending cases regardless of surgical case order (p<0.0001). For cases without complications, there was a statistically significant difference between attending case times for the first case of the day versus subsequent cases (60.55 and 49.06 minutes, respectively, p<0.0001). The same was true for residents (78.07 and 70.91 minutes, respectively, p=0.029).
Our results suggest that surgical case order may not affect complication rates of cataract surgery. However, the first case of the day was longer than subsequent cases, suggesting that a preoperative “warm-up” exercise may decrease cataract surgery case time. Given the overall low complication rate, future studies will need to look at more data, as well as compare the subset of straightforward to complex cataract surgeries.
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