Abstract
Purpose :
While the resident learning curve for phacoemulsification has been well-described, published literature report vast ranges of variability in the rates of adverse surgical events resulting from cataract operations. As such, this study aims to systematically review the evidence of intraoperative and postoperative complication rates and risk factors associated with resident-performed cataract procedures.
Methods :
We conducted a systematic review of studies that reported the prevalence, incidence and risk factors of complications in cataract surgeries as performed by resident surgical trainees. We searched MEDLINE, EMBASE, PubMed, Cochrane Library, CINAHL, and PsycINFO databases for relevant studies from inception to November 27, 2018. Two independent reviewers screened full-text articles to identify studies observing ophthalmology resident-performed cataract procedures reporting operative complications.
Results :
Sixty-two studies meeting the inclusion criteria were analyzed. Studies consisted of a total of 72,683 cataract cases largely utilizing the phacoemulsification technique with IOL implantation, with a minority describing consequences of M-SICS, ECCE, and ICCE procedures. The majority of studies were derived from academic institutions in the USA (n=30), United Kingdom (n=6) and India (n=6) with the remaining studies distributed sporadically across the globe. The most common and serious complications of resident-performed surgeries were posterior capsule rupture (n=1,549) and vitreous loss/prolapse (n=1,470). These accounted for approximately 35% of all major and minor intraoperative and postoperative procedures. Iris complications (n=645), anterior capsule tear (n=453), and dropped nucleus fragments in vitreous (n=199) were also noted as significant adverse events. Interestingly, in patients who experienced operative complications, approximately 4.7% of these patients required converted or corrective procedures mandating a return to the OR.
Conclusions :
Our study is the first systematic review and meta-analysis to demonstrate global prevalence rates of serious complications in cataract procedures performed by trainees. Moreover, our work identifies common adverse surgical outcomes which may be used as surrogate markers of a trainee's safety record and surgical competence.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.