Abstract
Purpose :
To use electronic health record (EHR) data to investigate the relationship between resident experience and cataract surgery outcome measures, including visual acuity and unplanned return to the operating room.
Methods :
EHR data were collected from cataract surgeries performed at the Johns Hopkins Wilmer Eye Institute from July 1, 2016 to March 1, 2020, and cases were categorized into resident or attending as primary surgeon. Pre-operative and post-operative visual acuity (VA) were recorded for each surgery, and data on unplanned return to OR were collected.
Results :
This study analyzed 14537 cataract surgery cases from July 1, 2016 to March 1, 2020. Out of 337 surgeries that could be attributed to residents with both pre-operative and post-operative VA data, 248 resident cases (73.6%) had better post-operative VA and 170 cases (50.5%) had more than 2 lines improvement in VA. There was no statistical difference in the proportion of cases with better post-operative VA or more than 2 lines improvement between resident and attending cases. The rate of unplanned return to the operating room within 90 days of cataract surgery was not statistically different between resident (1.8%) and attending (1.2%) surgeons.
Attending surgeons had a statistically greater proportion of cases with post-operative VA better than 20/40 but this finding has to be considered in the context that, on average, resident cases started out with poorer baseline visual acuity. Multivariable regression models of VA outcomes versus resident experience that controlled for pre-operative VA, patient age, American Society of Anesthesiologists (ASA) score, and estimated income showed that only pre-operative VA was statistically related to VA outcome.
Conclusions :
Resident experience was not related to VA outcomes but pre-operative VA, ASA classification, and attending/resident status were important in predicting post-operative VA. Given the impact of pre-operative VA on post-operative outcomes, VA cutoffs may not provide a high-quality metric to assess resident competency and experience. The use of EHR data can provide an ongoing way to evaluate and monitor resident cataract outcomes.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.