Abstract
Purpose :
To compare cumulative dissipated energy (CDE), case time, and posterior capsule complication rates between Pop and Chop (PC) and Divide and Conquer (DC) cases performed by residents and an attending surgeon.
Methods :
In this retrospective study, 141 cases of phacoemulsification performed by two resident surgeons at the Hampton VA Hospital are compared to 150 consecutive cases performed by a highly experienced attending surgeon at a free standing ASC. Resident cases were randomly assigned to different techniques, while the attending performed both PC and DC according to his preference. All cases were performed using the Centurion Vision System (Alcon Labs) with similar settings and hand piece. Case time, CDE, posterior capsule complications, and demographic data were recorded for each case and compared between and within surgical techniques and surgeon skill levels.
Results :
The average patient age was 68.7 in attending cases and 67.0 in resident cases (p=0.11). Of the resident cases, 81 were DC and 60 were PC. In the attending group, 18 were DC and 132 were PC. The average CDE for resident PC was 9.2 versus 15.3 for the attending (p<0.0001). The average CDE for resident DC was 17.4 versus 26.3 for the attending (p=0.016). The average resident case time for PC was 22.5 versus 4.9 minutes for the attending (p<0.0001). The average resident case time for DC was 29.8 versus 7.8 minutes for the attending surgeon (p<0.0001). The posterior capsule complication rate for resident PC was 6.7% versus 1.5% for the attending (p<0.001) and 6.0% for resident DC versus 0.0% for the attending (p<0.0001). CDE for PC was significantly less than DC for residents (p<0.001) and the attending (p<0.0001). Case time for PC was significantly less than DC for residents (p<0.001). and the attending (p<0.001).
Conclusions :
We found that case time and complication rates are useful measures of surgical proficiency. The attending surgeon performed cases approximately four times faster and with 75% fewer complications than residents regardless of surgical technique. On the other hand, CDE was not correlated with surgical experience as the attending used more CDE than the residents for both techniques. CDE and case time were found to be good measures for comparing techniques: PC cases used significantly less CDE and case time for both attending and resident surgeons compared to DC cases.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.