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Pedro C. Carricondo, Ana C. Fortes, Valerio H. Santos, Amaryllis Avakian, Marcelo C. Tannous, Jose A. Bonatti, Newton Kara-Jose; Costs And Complications Of Resident Phacoemulsification Learning Curve in Brazil. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4719.
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The aim of this study is to compare the costs and complications of cataract surgery performed by residents with the surgery performed by an experienced surgeon.
In this prospective study, the phacoemulsification performed by residents during the first 3 months of training was compared with surgery performed by an experienced surgeon about the costs and complications. There were included 312 surgeries; residents performed 261 and an experienced surgeon performed 51. The surgeries were divided according to resident surgical experience at the time of performing the procedure (Group 1: 00-40 surgery, Group 2: 41-80 surgeries and group 3: more than 80 surgeries).
The mean cost observed in the first 40 resident phacoemulsification surgeries was 46,52% higher than the surgeries performed by a experienced surgeon; between 40 and 80 surgeries, the mean cost was 37,58% higher and in the group with more than 80 surgeries, the mean cost was 19,26% higher. The costs observed in resident phacoemulsification surgeries were in all moments above the amount paid by the brazilian public health system. Regarding the time of surgery, was observed in surgeries performed by residents 54.2 ± 23.4 minutes and in the surgery control group (surgeon) 36.0 ± 15.3 minutes. The time observed in group 1 was 57.6 ± 23.0 minutes; in group 2 was 54.6 ± 24.7 minutes and in group 3 was 49.0 ± 18.3 minutes. All comparisons were statistically significant (P <0.05). The complication rate found in surgeries performed by residents was 11.49% and the surgery performed by experienced surgeons was 1.92%. In group 1 we observed rates of 9.65% of posterior capsule rupture and 8.77% of vitreous loss; in group 2 was observed rate of 7.37% of capsule rupture and 4.21% of vitreous loss and in group 3 was observed rate of 5.77% of capsule rupture and 3.85% of vitreous loss. These complications were not observed in the surgery control group.
Cataract surgery performed by the resident is a statistically significant increase in spending for the service and an increased risk of complications for patients. This difference progressively decreases with the completion of more procedures, demonstrating the effect of training. This paper presents a new method to evaluate the resident phacoemulsification learning curve.
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