The study investigates the impact of ophthalmology residents’ experience on cataract surgery outcomes, addressing the need for improved patient safety and surgical efficiency in the face of increasing cataract prevalence and economic burden. |
The hypothesis was that greater experience levels among residents would enhance surgical outcomes and that systematic preoperative risk assessments could optimize surgeon–patient pairings. |
Increased experience in residents was associated with better outcomes in high-risk cataract surgeries, with fewer intraoperative complications. |
Strategic assignments based on preoperative risk evaluations can improve patient outcomes, suggesting that the integration of these assessments into surgical training may be beneficial. Sensitivity analyses confirmed the study’s findings, supporting the reliability of the conclusions drawn. |
The study’s outcomes highlight the potential for experience-based task assignments to serve as a model for improving the educational curriculum of ophthalmology residents, potentially influencing policy decisions in clinical training programs. |
Introduction
Methods
Participants
Risk Factors of Study Participants
Description of the Surgical Procedure
Surgical Complications
Surgical Outcomes
Statistical Analysis
Results
Patient Characteristics
Risk Factors
Risk Factors and Residency Experience
Risk factor (n = 691) | 1st year n = 185 | > 1st year n = 506 | p | 2nd year n = 193 | > 2nd year n = 313 | p | 3rd year n = 142 | > 3rd year n = 171 | p | 4th year n = 102 | > 4th year n = 69 | p |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Diabetic retinopathy | 12 (6%) | 40 (8%) | 0.53 | 15 (8%) | 25 (8%) | 0.93 | 15 (10%) | 10 (6%) | 0.12 | 8 (8%) | 2 (3%) | 0.17 |
Fuchs endothelial dystrophy | 0 | 10 (2%) | 0.05 | 0 | 10 (3%) | 0.01 | 4 (3%) | 6 (3%) | 0.73 | 3 (3%) | 3 (4%) | 0.62 |
Oral alpha-1 antagonists | 12 (6%) | 76 (15%) | 0.003 | 26 (13%) | 50 (16%) | 0.44 | 21 (15%) | 29 (17%) | 0.60 | 19 (18%) | 10 (14%) | 0.48 |
Lens phacodonesis | 2 (1%) | 23 (5%) | 0.03 | 9 (4%) | 14 (5%) | 0.92 | 3 (2%) | 11 (6%) | 0.06 | 3 (3%) | 8 (11%) | 0.02 |
Shallow anterior chamber | 2 (1%) | 25 (5%) | 0.02 | 8 (4%) | 17 (5%) | 0.52 | 6 (4%) | 11 (6%) | 0.39 | 8 (8%) | 3 (4%) | 0.36 |
Small pupil | 12 (6%) | 92 (18%) | < 0.001 | 31 (16%) | 61 (19%) | 0.33 | 22(15%) | 39 (223%) | 0.10 | 22 (22%) | 17 (25%) | 0.64 |
Previous vitrectomy | 1 (< 1%) | 2 (< 1%) | 0.79 | 1 (< 1%) | 1 (< 1%) | 0.73 | 0 | 1 (1%) | 0.36 | 0 | 1 (1%) | 0.22 |
Poor cooperation | 28 (15%) | 166 (33%) | < 0.001 | 49 (25%) | 117 (37%) | 0.005 | 47 (33%) | 70 (41%) | 0.15 | 44 (43%) | 26 (38%) | 0.48 |
Only eye | 3 (2%) | 9 (2%) | 0.89 | 2 (1%) | 7 (2%) | 0.32 | 2 (1%) | 5 (3%) | 0.37 | 4 (4%) | 1 (1%) | 0.35 |
Axial < 21.5 mm or > 30 mm | 4 (2%) | 11 (2%) | 0.99 | 6 (3%) | 5 (2%) | 0.26 | 3 (2%) | 2 (1%) | 0.51 | 1 (1%) | 1 (1%) | 0.78 |
Axial < 26–30 | 7 (4%) | 34 (7%) | 0.15 | 11 (6%) | 23 (7%) | 0.47 | 6 (4%) | 17 (10%) | 0.05 | 9 (9%) | 8 (11%) | 0.55 |
Dense cataract | 43 (23%) | 220 (44%) | < 0.001 | 75 (39%) | 145 (46%) | 0.10 | 63 (44%) | 82 (48%) | 0.52 | 48 (47%) | 34 (49%) | 0.77 |
Age > 90 | 5 (3%) | 13 (3%) | 0.92 | 4 (2%) | 9 (3%) | 0.58 | 3 (2%) | 6 (3%) | 0.46 | 5 (5%) | 1 (1%) | 0.23 |
Age 80–90 | 25 (13%) | 109 (22%) | 0.02 | 35 (18%) | 74 (24%) | 0.14 | 29 (20%) | 45 (26%) | 0.22 | 25 (24%) | 20 (29%) | 0.51 |
Sum of risk factors† | 0.84 ± 1.0 | 1.64 ± 1.34 | < 0.001 | 1.4 ± 1.19 | 1.78 ± 1.42 | 0.005 | 1.57 ± 1.31 | 1.95 ± 1.52 | 0.08 | 1.95 ± 1.4 | 1.95 ± 1.59 | 0.90 |
Any risk factor | 101 (54%) | 394 (78%) | < 0.001 | 147 (76%) | 247 (79%) | 0.47 | 108 (76) | 139 (81%) | 0.26 | 84 (82%) | 55 (79%) | 0.66 |
Pre-score† | 1.6 ± 2.0 | 3.2 ± 2.7 | < 0.001 | 2.8 ± 2.5 | 3.5 ± 2.8 | 0.005 | 3.1 ± 2.6 | 3.8 ± 3.0 | 0.03 | 3.8 ± 2.9 | 4.0 ± 3.0 | 0.83 |
Risk Factors Associated with CDVA
Surgical Complications
Surgical Complications in Relation to Residency Experience
Complications (n = 691) | 1st year n = 185 | > 1st year n = 506 | p | 2nd year n = 193 | > 2nd year n = 313 | p | 3rd year n = 142 | > 3rd year n = 171 | p | 4th year n = 102 | > 4th year n = 69 | p |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Anterior capsule tear | 4 (2%) | 7 (1%) | 0.468 | 0 | 7 (2%) | 0.036 | 4 (3%) | 3 (2%) | 0.526 | 2 (2%) | 1 (1%) | 0.802 |
Posterior capsule tear | 23 (12%) | 37 (7%) | 0.034 | 17 (9%) | 20 (6%) | 0.310 | 8 (6%) | 12 (7%) | 0.61 | 11 (11%) | 1 (1%) | 0.019 |
Vitreous loss | 12 (6%) | 22 (4%) | 0.249 | 9 (5%) | 13 (4%) | 0.784 | 7 (5%) | 6 (4%) | 0.53 | 6 (6%) | 0 | 0.04 |
Iris prolapse | 2 (1%) | 7 (1%) | 0.756 | 4 (2%) | 3 (1%) | 0.297 | 1 (1%) | 2 (1%) | 0.674 | 2 (2%) | 0 | 0.242 |
Hyphema | 0 | 1 (< 1%) | 0.545 | 1 (1%) | 0 | 0.202 | 0 | 0 | NA | 0 | 0 | NA |
Zonular fiber loss | 2 (1%) | 4 (1%) | 0.715 | 1 (1%) | 3 (1%) | 0.586 | 1 (1%) | 2 (1%) | 0.674 | 2 (2%) | 0 | 0.242 |
Dropped lens | 2(1%) | 5 (1%) | 0.914 | 2 (1%) | 3 (1%) | 0.931 | 2 (1%) | 1 (1%) | 0.456 | 1 (1%) | 0 | 0.409 |
Intraocular lens (IOL) | 0 | 1 (< 1%) | 0.545 | 0 | 1 (< 1%) | 0.4319 | 1 (1%) | 0 | 0.271 | 0 | 0 | NA |
Wound leakage requiring sutures | 3 (2%) | 10 (2%) | 0.761 | 7 (4%) | 3 (1%) | 0.036 | 1 (1%) | 2 (1%) | 0.674 | 1 (1%) | 1 (1%) | 0.779 |
Membrane damage | 0 | 2 (< 1%) | 0.391 | 1 (1%) | 1 (< 1%) | 0.729 | 0 | 1 (< 1%) | 0.361 | 1 (1%) | 0 | 0.409 |
Extracapsular cataract extraction (ECCE) | 0 | 3 (1%) | 0.293 | 1 (1%) | 2 (1%) | 0.863 | 1 (1%) | 1 (1%) | 0.895 | 0 | 1 (1%) | 0.222 |
Any complication | 31 (17%) | 62 (12%) | 0.124 | 26 (13%) | 36 (12%) | 0.511 | 15 (11%) | 21 (12%) | 0.635 | 17 (17%) | 4 (6%) | 0.034 |
Sum of complications† | 0.25 ± 0.64 | 0.19 ± 0.57 | 0.08 | 0.21 ± 0.63 | 0.17 ± 0.54 | 0.464 | 0.17 ± 0.58 | 0.17 ± 0.5 | 0.658 | 0.25 ± 0.62 | 0.04 ± 0.230 | 0.012 |