Abstract
Purpose :
Resident surgeons are quoted to take an average of 12 minutes longer when compared to an attending physician. Studies have shown that operative time may impact complications and outcomes in cataract surgery, but this observation is up for debate. This study aims to show the impact of operative time on early postoperative outcomes in resident cataract surgery.
Methods :
This retrospective case series includes 100 randomly selected eyes from 100 patients from all PGY-4 resident cataract surgeries performed at a single Veterans Affairs Hospital between March 1, 2018 and March 31, 2020. Eyes with attending as primary surgeon or laser-assisted cataract surgery were excluded. Electronic medical records were reviewed to extract age, nuclear sclerotic cataract grade, and operative factors (use of epinephrine, use of trypan blue, iris expansion device (IED), cumulative dissipated energy (CDE), and operative time). Post-operative outcomes were reviewed, including visual acuity (VA) and intraocular pressure (IOP). Multiple ordinal logistic regression was performed to assess impact of risk factors on post-operative visual acuity.
Results :
Operative time (OR=0.95, CI=0.92-0.99, p=0.01) and use of IED (OR= 0.07, CI= 0.01-0.03, p=0.001) are inversely associated with post-operative day one (POD1) pinhole visual acuity when controlling for co-variates as listed above. Other factors including CDE (OR=0.96, CI=0.90-1.03, p=0.29) are not significantly associated. No risk factors are significantly associated with decreased postop week one or month one best corrected visual acuity.
Conclusions :
The results suggest that increased resident operative time is a significant risk factor for decreased POD1 pinhole VA, independent of CDE and other operative factors. At the one week and one month, however, resident operative time is not significantly associated with VA, suggesting that resident operative time has minimal effect on long-term VA outcomes. Interestingly, CDE is not significantly associated with decreased VA at any stage in our sample of 100 patients. Understanding effects of resident operative time on early VA outcomes improves understanding of trainee surgery and improves patient counseling when trainees are involved. Safely minimizing intraoperative delays shows promise as a method of improving early post-operative visual outcomes.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.