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Ankur Gupta, Sandra M Johnson, Joshua Nunn, Eric Areiter; Mature Cataract Surgery Outcomes Stratified by Surgeon Experience. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2807.
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To determine whether surgeon experience level is associated with differences in surgical outcome and complication rates in patients undergoing mature cataract extraction.
We performed a retrospective case review of mature cataract extractions performed at the University of Virginia between April 2008 and June 2013. Inclusion criteria were preoperative best corrected visual acuity (BCVA) worse than 20/200 and consistent cataract changes. Subjects were grouped according to surgeon training level. Primary endpoints were improvement in BCVA and incidence of surgical complications. We also collected data on pre-existing ocular comorbidities and risk factors for vitreous loss.
466 patients met inclusion criteria, of which 343 completed a minimum of 45 days of postoperative follow up. 42% of patients had one or more pre-existing ocular comorbidity or risk factor for vitreous loss. 89.8% of patients saw a postoperative improvement in BCVA, and 17.8% experienced any complication. BCVA improvement and complication incidence, respectively, according to surgeon group were as follows: novice residents (94.1%, 18.8%), experienced residents (98.7%, 15.8%), fellows (68.6%, 22.9%), and attending surgeons (87.0%, 16.8%).
There were no significant differences observed in the success rate among resident surgeon groups. In addition, their complication rate was comparable to that of fellows and attending surgeons. The success rates for fellows and attendings were lower at 68.6% and 87.0%, respectively. Attending surgeons and fellows take on more patients with pre-existing conditions creating a selection bias that may account for the lower rates of postoperative success. Indeed, 80.0% of fellow patients and 45.8% of attending patients had at least one pre-existing condition or risk factor, compared with 31.6% of resident patients. Based on the above data, resident surgeons performing mature cataract extractions with supervision is acceptable for patient safety and quality of care. Formal statistical analysis will be presented, along with complete data on patients in our study who continue to meet endpoints.
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