Abstract
Purpose :
To compare intraoperative material utilization during phacoemulsification surgeries performed by trainees versus experienced surgeons.
Methods :
This study included phacoemulsification surgeries performed by three experienced surgeons (EX) and seven resident trainees (RS) over one academic year. Exclusion criteria included prior ocular surgeries or intravitreal injections, combined surgery, preoperative best-corrected visual acuity worse than 20/200, and history of trauma or pseudoexfoliation syndrome. Resources additional to that of routine cataract surgery were enumerated for each case, including viscoelastic, trypan blue, balanced salt solution (BSS), iris expanders, miotic agents, sutures, and capsular support devices. The surgery duration and presence of complications were also noted. Data analysis using rank sum, chi square, Fischer, or student t-tests were used when appropriate.
Results :
The 584 EX and 149 RS cases had no significant differences in patient demographics. EX used 23 additional units of resources per 100 cases, while RS used 58 (p<0.001). Overall, 111 (19%) EX cases required extra materials compared to 52 (35%) RS cases (p<0.001). The majority of these cases required only one additional resource (16% of EX and 23% RS), compared to those that needed two (2.7% EX and 6.7% RS) or more than three additional resources (0.68% EX and 5.4% RS). Additional viscoelastic, trypan blue, BSS, and sutures were used more frequently in the RS cases, whereas there was no statistical difference in the utilization of intracameral miotic agents, iris expander, or capsular support devices between the two groups. Junior residents (PGY-3) consumed more resources than their senior counterparts (PGY-4), 58% versus 22% respectively, (p<0.001). More complications occurred in the RS group (2.0%) than in the EX group (0.0%, p=0.008). The median surgery duration was 21 minutes [interquartile range: 18-27] for RS compared to 10 minutes [8-12] for EX (p < 0.001).
Conclusions :
Overall, residents used more intraoperative materials than experienced surgeons did during cataract surgeries. The additional utilization of resources, increased surgery duration, and higher complication rate of resident-performed cataract surgeries are likely associated with increased costs for institutions where trainees perform surgery.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.