Impact of changes in attending staffing on major cataract complications at Veterans Affairs Boston Healthcare System

Abstract

 

Purpose

 

Studies have found a reduction in intraoperative cataract surgery complications with surgeon experience. However, there is little data examining the relationship between average attending FTE at an academic teaching institution and the institutional complication rate. This study hypothesizes that increased average tours of duty amongst the attending staff will decrease intraoperative cataract complication rates in surgeries performed by residents in their first month of PGY4 at the Veterans Affairs Boston Healthcare System (VABHS).

 

Methods

 

All ophthalmologic procedures at VABHS in the month of July of each year from 2004 until 2011 were screened for phacoemulsification/intraocular lens implantation (PE/PCIOL) or extracapsular cataract extraction (ECCE). The following primary outcomes were recorded: anterior vitrectomy, posterior rent, anterior chamber intraocular lens, anterior rent with posterior capsular rent or vitreous loss, retinal tear or detachment within 30 days, retained material, sulcus intraocular lens with posterior capsular rent and an additional complication (i.e. vitreous loss, anterior vitrectomy, zonular dehiscence, retained material), and return to operating room in 30 days. Complication rates for each academic year were compared according to known staffing levels those years (i.e. number of attending ophthalmologists on staff, full time/part time status).

 

Results

 

Percentage of cases with complications decreased from 23.1% in July 2004 to 8.8% in July 2011. Average tour of duty for all staff increased from 11.9 hours/week to 19.3 hours/week. Percent of attending staff working more than 8 hours/week also rose from 33.3% to 61.9%.

 

Conclusions

 

The incidence of intraoperative complications in cataract surgeries performed by residents in the first month of PGY4 decreased from July 2004 to July 2011 while average tour of duty for staff increased, supporting our original hypothesis. Further research evaluating complications for the course of the entire study period, 2004-2011, is necessary to assess the full association between staffing tours of duty and intraoperative complications.

 

 

Fig 1. Percent Staff with Tours of Duty > 8 hours/week and major complication rates in July of 2004-2011

 

 

Fig 2. Average tour of duty for attending staff and major complication rates in July of 2004-2011

 

Keywords: 445 cataract • 462 clinical (human) or epidemiologic studies: outcomes/complications • 737 training/teaching cataract surgery