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D. Eisenstein, J. Hu, A. Chomsky; Evaluation of Resident Performed Cataract Surgery Learning Curve by Complication Rates. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5444.
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Cataract surgery is one of the most commonly performed surgeries in the world, with over 1 million procedures performed per year in the United States alone. In 2002 a resident survey revealed that the number of phacoemulsification procedures performed by a single resident ranged from 50 to 300; the majority performed between 80 and 140 (avg. 120), and 25% performed less than 80. In 2007, the Residency Review Committee of the Accreditation Council for Graduate Medical Education (ACGME) increased the minimum number of resident performed phacoemulsification procedures from 45 to 86. The aim of this study is to identify a case number for which a statistically significant decline in complication rates occurs.
Retrospective chart review of resident performed phacoemulsification procedures during a 6 year period at The VA Hospital, Tennessee Valley Healthcare System in Nashville. The surgical cases were categorized based on the masked resident surgeon performing the cataract surgery, and then sorted chronologically and given a sequential case number. The total number of intraoperative complications including posterior capsular tear, vitreous loss, and retained lens fragments were recorded, as well as the case numbers for which they occurred.
1442 cases were performed during the time period by 19 different resident surgeons. For the purpose of complication rate analysis, the cases were divided into groups spanning every 20 procedures. A Statistical analysis using chi square analysis calculating 95% confidence intervals was performed. The analysis showed a statistically significant decrease in intraoperative complications in resident performed phacoemulsification cataract surgery once the surgeon had performed 80 procedures; 61-80 for Posterior Capsular Tears and 41-60 for Vitreous Loss.
This study suggests improvement in complication rates of resident performed cataract surgery between 41-80 procedures, specifically posterior capsular rupture and vitreous loss . The results of this study seem to support the ACGME recommendation to increase the minimum amount of phacoemulsification procedures from 45 to 86. There was also a decreasing trend of intraoperative complication rate with increasing surgical experience beyond this as well. The limitations of the study include its retrospective nature and a review limited to one specific training program.
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