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John Yu Cheng, Steven Isaac Beigelman, Tambari Piawah, Avi S. Robinson; Effect of Resident Involvement in Ophthalmic Surgery on Patient Outcomes: A Meta-Analysis. Invest. Ophthalmol. Vis. Sci. 2021;62(8):2647.
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This study seeks to determine the effect of resident- versus attending-performed surgeries on patient outcomes in ophthalmic surgery.
This paper followed Preferred Reporting Items of Systematic Reviews and Meta-Analyses guidelines. Two independent authors searched PubMed, EMBASE, and Cochrane Library from inception to July 2020 to find studies assessing the impact of resident involvement on patient outcomes in ophthalmic cases. All included studies utilized non-overlapping patient populations. 10 patient characteristics were compared between resident and attending arms to investigate participant similarity. 24 outcome variables potentially impacted by resident involvement were compared in this analysis. Study quality was assessed using Newcastle-Ottawa Scale for cohort analysis and given a quality label per Agency for Healthcare Research and Quality standards.
17 studies were included in this meta-analysis. The highest quality studies were those that employed propensity scoring in their patient analysis. Pooled estimate of only high-quality evidence demonstrated few negative effects of resident involvement. When considering these high-quality studies, the only statistically significant effects observed in the resident-performed arm were longer operative times (mean difference, 12.04 minutes; [95% confidence interval (CI)],[3.91, 20.17]), and increased odds of unplanned return to the OR (odds ratio, 2.58; [95% CI], [1.31, 5.06]), primarily related to nonspecific early postoperative complications in different surgery types with steep learning curves. Analysis of operative time, using propensity scored papers, included 3 studies with 260 patients. Analysis of odds of requiring reoperation, using propensity scored papers, included 4 studies with 342 patients. There was no significant difference between resident- and attending-performed surgeries in 15 other measured postoperative complications in these studies. Significant heterogeneity (I2>50%) was present in 1 of 15 outcomes.
When high-quality studies are considered, resident involvement in ophthalmic surgery has few negative effects on patient success rates and appears safe in carefully selected patients. We recommend future studies on this comparison, given limited sample size of this analysis.
This is a 2021 ARVO Annual Meeting abstract.
PRISMA flow diagram of study selection
Chart showing procedure & sample size of surgical cases included in high-quality studies.
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