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Mohsin Chowdhury, Jamie B. Rosenberg, Jessica G. Lee, Lewis A. Eisen, Assumpta A. Madu; Evaluation Of A Warm-up Effect In Resident-performed Cataract Surgery. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6733.
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Learning phacoemulsification cataract surgery is fundamental for ophthalmology residents. Recent studies in other surgical fields have shown that simple surgical exercises done preoperatively as a warm-up routine for 15-20 minutes improve surgical performance. However, there is a paucity of research studying the benefits of warm-up exercises for cataract surgery. We hypothesized that a warm-up effect would be demonstrated by comparing the first case of the day to later cases, in terms of length of surgery and intraoperative complication rates.
With IRB approval, we reviewed the operative reports of 384 patients that underwent resident-performed phacoemulsification between January 22, 2009 and June 16, 2011. The date and time of surgery, order of surgery in the day, and length of surgery were recorded. Other data extracted included intraoperative complications such as vitreous loss, zonular dehiscence, need for anterior vitrectomy, and retained lens material. Statistical analysis was done with SPSS version 19.
There was a trend for the 5th case of the day to be faster than the 1st case of the day (47.50 minutes ± 16.55 vs. 56.52 minutes ± 22.81, p=0.099). For surgeries performed between July and December, when residents were beginning their training in cataract surgery, the difference was statistically significant (35.67 minutes ± 6.66 vs. 63.90 minutes ± 24.71, p=0.002). There were more intraoperative complications in the 1st case compared to all other cases (23.8 vs. 18.5%), although this difference was not statistically significant (p=0.245).
There is a warm-up effect in resident performed cataract surgeries, with residents performing surgeries more quickly later in the day. This difference is most apparent when they are beginning their training in cataract surgery. Strategies such as utilization of a surgical simulator prior to the 1st case of the day should be explored to potentially decrease the length of time as well as the complication rates of early cases.
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