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J. L. Rizzo, C. Shortsleeve-Ament, P. Legutko, M. K. Daly; Association Between Time of Training and Resident Surgeon Phacoemulsification Cataract Surgery Complication Rates. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5588.
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The Accreditation Council for Graduate Medical Education oversees ophthalmology residency programs in the United States and requires each resident to complete a minimum number of phacoemulsification (PE) cataract surgery cases. This study compares the resident PE cataract surgery complication rates in the ophthalmology service of the Veterans Affairs Boston Healthcare System (VA BHS) during different times of the academic year. The intent is to determine if length of time in training is a determinant of risk for surgical complications. The VA BHS is a unique surgical environment that hosts residents from two separate training programs.
After obtaining approval from the Institutional Review Board, medical records were reviewed for 549 patients who underwent PE cataract surgery between July 1, 2006, and July 1, 2007, with a PGY-4 ophthalmology resident as the primary surgeon. Twelve residents were evaluated during the course of this academic year. Records were examined for evidence of complications, including posterior capsule rent with and without anterior vitrectomy, anterior capsule rent, Descemet membrane tear, dropped lens fragments, zonular dehiscence, iris sphincter tear, and iris incarceration or damage.
Complication rates for all types of complications reviewed in this study are highest at the beginning of the academic year and decrease during the course of the year. The average complication rate involving posterior capsular rupture with anterior vitrectomy over the course of the academic year was 5%. However, the decrease in the complication rate over each four month interval was statistically significant: an average of 11% during the first four months of training, 4% during the second four-month period, and 2% during the last four months of training (p=0.001).
The high complication rates during the initial months of the academic year are statistically significant, and disclosure of this information should be considered during the process of informed consent.
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