Resident-performed Cataract Surgery Research Articles

Outcomes of resident physician-performed cataract surgery in a diverse veterans affairs health system population.

To evaluate visual acuity (VA) outcomes and complications from resident physician-performed cataract surgery in a diverse Veterans Affairs Hospital population. A retrospective chart review was conducted for patients who underwent cataract surgery performed by resident physicians from 01/01/2013 to 12/31/2015 at the Veterans Affairs Medical Center. Intraoperative and postoperative clinical information, best-corrected VA (BCVA) (1 day, months 1, 2-3, and 6), and surgery complications were extracted. Univariable and multivariable linear regression models were performed for risk factors of BCVA change. This study included 1183 patients, with mean (SD) age of 70.8 (9.3) years. 1154 (97.5%) were males, 493 (41.7%) African-American, and 681 (57.6%) Caucasian. The mean (SD) VA in logMAR was 0.69 (0.74) at baseline, improved to 0.19 (0.36) at 1 month, 0.16 (0.34) at 2-3 months, and 0.14 (0.36) at 6 months. 1080 (91.3%) patients experienced VA improvement from baseline and 1023 (86.5%) patients achieved at least 20/40 BCVA at 1 month. There were 86 (7.3%) complications, most commonly including 47 (4.0%) posterior capsular tears and 64 (5.4%) vitreous loss. In multivariable analysis, younger age (P < 0.0001), worse baseline VA (P < 0.0001), and absence of iris prolapse (P < 0.001) were significantly associated with greater improvement in VA at 1 month. In a diverse VAMC, resident-performed cataract surgeries achieved significant improvement in VA with a cumulative complication rate lower than previously reported. Resident physician education may benefit from specific focus on prevention of iris prolapse and better incision construction during surgery as these intraoperative events often led to delayed stabilization of visual outcome beyond 1 month.

The impact of case complexity in resident-performed cataract surgery.

To evaluate the association of capsular dye and/or a pupil expansion device (PED) usage on the rate of major complication in resident-performed cataract extraction. Resident cataract surgeries between 2016 and 2019 were included. The primary outcomes were anterior or posterior vitrectomy (AVx and PPVx). Cases were grouped by the use of a PED and/or capsular staining along with additional preoperative risk factors. Of the 1,348 cases, 371 (27.5%) documented capsular staining ("Dye-only"), 91 (6.8%) required pupil expansion ("PED-only"), and 100 (7.4%) used both capsular stain and a PED ("Both"). The remainder of cases (n=786, 58.3%) were classified as "Routine." Compared to the "Routine" group, "PED-only" and "Both" had significantly higher odds of an AVx (OR=2.90, 95% CI 1.27-6.19, P=0.01) and/or a PPVx (OR=2.33, 95% CI 1.07-5.12, P=0.04). Among the PPVx cases, the "PED-only" group has significantly higher odds than "Routine" and "Dye-only" (OR=4.64, 95% CI 1.68-12.79, P=0.01; and OR=6.48, 95% CI 1.7-25.0, P=0.005, respectively). In case-control analysis, vision, intraocular pressure, anterior chamber depth, axial length, cataract type, or severity had no significant overall association with complication. When compared to nuclear sclerotic cataract, posterior subcapsular (OR=7.86, 95% CI 1.46-42.47, P=0.017) and white/mature cataracts (OR=3.05, 95% CI 1.1-8.43, P=0.032) had increased odds of complication. Resident-performed cataract surgery frequently required capsular staining and/or a PED, and intuitively, these cases had a higher overall complication rate compared to routine cases. However, the use of a PED independently was associated with significantly higher odds of a major complication requiring an unplanned vitrectomy independent of predisposing factors.

Resident-Performed Phacoemulsification Cataract Surgery: Impact of Resident-Level Characteristics.

To evaluate the rate of complications in resident-performed phacoemulsification and influencing factors. In this retrospective cohort study, the outcomes of cataract surgeries performed by 18 ophthalmology residents were analyzed. The outcome of first 80 phacoemulsification cataract surgeries (1440 cataract surgeries) performed by each resident were analyzed. Outcome measures included the rate of intraoperative capsular rupture requiring anterior vitrectomy, nucleus drop, and incomplete attempts at uncomplicated procedures. Changes in the rate of complications over the surgical training course were also assessed. The most common surgical complications were capsular rupture (7.5%), followed by incomplete attempt(s) (5.9%), and nucleus drop (1.1%). Comparing the first 40 and second 40 surgeries, the rate of complications decreased as a function of surgeon experience in all resident cohorts. Greater theoretical skills and younger surgeon age were associated with a lower rate of intraoperative capsular rupture (hazard ratios = 1.421 and 1.481, respectively; P = 0.047 and P = 0.041, respectively). The use of antianxiety drugs and number of surgeries in the first 6 months demonstrated no predictive value for a lower rate of intraoperative complications (hazard ratios = 0.929 and 1.002; P = 0.711 and P = 0.745, respectively). The use of antianxiety medication and more surgeries in the first 6 months did not decrease the rate of intraoperative complications of phacoemulsification, while improvement of theoretical skills may have increased the safety of resident-performed cataract surgery.

Oral anxiolytics prior to routine resident cataract surgery eliminate need for intravenous sedation at a Veterans Affairs Hospital

PurposeTo assess the frequency of intraoperative intravenous sedation administration during routine resident-performed cataract surgery among patients receiving pre-operative oral sedation at a Veterans Affairs Medical Center and its impact on patient safety and system cost. MethodsRetrospective review of all resident-performed cataract surgeries performed at the Iowa City Veterans Affairs Medical Center in 2013 and 2017. Cases monitored by a registered nurse were included. Combined cases and cases monitored by an anesthesia provider were excluded. Pre-operative placement of an intravenous (IV) catheter, administration of intra-operative IV sedation, oral diazepam administration, anesthesia type, conditions for administering intraoperative IV medication, and cost of IV catheter placement were recorded. ResultsOf 1025 patient cases included for analysis, 972 received pre-operative diazepam (94.9%) and 1017 (99.3%) had IV catheters placed. One patient received a planned dose of IV methylprednisolone. Zero patients received supplemental intraoperative IV sedation. The estimated materials cost of unused IV catheters was $10,668 over 2 years. ConclusionsPre-operative IV catheter placement may not be necessary in patients undergoing routine resident cataract surgery with pre-operative oral sedation. Discontinuation of routine IV placement may improve patient satisfaction and decrease health care costs without compromising patient safety.

Incidence of postoperative week 1 management changes after resident-performed phacoemulsification cataract surgery

BackgroundThe goal of this study was to investigate the incidence of departures from routine care at the postoperative week 1 (POW1) visit following uneventful resident-performed cataract surgery in asymptomatic patients who had a normal postoperative day 1 (POD1) examination.MethodsA retrospective chart review of phacoemulsification surgeries performed by the senior resident class at Montefiore Medical Center between June 20, 2018 and April 1, 2019 was performed. The most recent preoperative visit note, operative report, POD1 visit note, and POW1 visit note were evaluated and variables were recorded. Exclusion criteria consisted of any complications that would have necessitated close follow-up and a POW1 visit, whether discovered preoperatively, intraoperatively, at the POD1 visit, or leading up to the POW1 visit. The primary outcome measure was the incidence of unanticipated management changes at the POW1 visit following resident-performed cataract surgery.ResultsThe charts of 292 surgical cases of 234 patients that underwent phacoemulsification with intraocular lens implantation were reviewed. 226 cases (77%) had an uncomplicated pseudophakic fellow-eye history, with a routine surgery, and POD1 examination. 19 of these patients had symptomatic presentations at the POW1 timepoint, and an additional 30 had no POW1 visit at all. In total, 177 cases were included in the study, and only 4 of these cases (2.3%) had an unexpected management change at the POW1 visit.ConclusionsAsymptomatic patients who underwent uncomplicated cataract surgeries performed by resident surgeons followed by a routine POD1 visit had a low incidence of unexpected management changes at the POW1 visit. These results suggest that regularly scheduled POW1 visits could potentially be omitted for patients deemed to be at low risk for complications, and instead performed on an as-needed basis.

Resident-performed immediate sequential bilateral cataract surgery during the COVID-19 pandemic.

Purpose:To assess visual outcomes and patient satisfaction for senior resident-performed immediate sequential bilateral cataract surgery (ISBCS) versus delayed sequential bilateral cataract surgery (DSBCS) during the COVID-19 pandemic, when minimizing healthcare-related exposures for patients and providers are paramount.Methods:This was a pilot retrospective cohort study of all ISBCS and DSBCS patients who underwent senior resident-performed cataract surgery from May to September 2020 at a single academic institution. Outcome measures were final corrected distance visual acuity (CDVA), final manifest refraction (MRx), intraoperative and postoperative complications rates, total number of visits, and patient satisfaction assessed postoperatively by telephone questionnaire.Results:Twenty-two eyes of 14 patients and 56 eyes of 28 patients underwent senior resident-performed ISBCS and DSBCS, respectively. Final CDVA was 20/25 or better in 21 (95%) ISBCS and 51 (91%) DSBCS eyes (P = 0.670). Deviation of final MRx from target refraction was within 0.50 D in 17 (77%) ISBCS and 47 (84%) DSBCS eyes (P = 0.522). There was no significant difference in intraoperative (P = 1.000) or postoperative (P = 1.000) complications. ISBCS patients averaged 3.5 fewer visits than DSBCS patients (5.9 vs 9.5, P < 0.001). All ISBCS and 20 DSBCS patients (87%) reported they were “very satisfied” or “satisfied” with their experience (P = 0.701). Five of six senior residents responded that they preferred performing ISBCS over DSBCS.Conclusion:This early experience suggests that senior resident-performed ISBCS is as safe and effective as DSBCS, with the added benefit of averaging fewer in-person visits. Residency programs should consider offering senior resident-performed ISBCS to select patients during the COVID-19 pandemic.

Comparing Resident Outcomes in Cataract Surgery at Different Levels of Experience.

PurposeTo evaluate outcomes of resident-performed cataract surgeries in different training levels in a retrospective case series.Patients and MethodsA total of 730 surgeries performed by residents were evaluated into three groups: surgeries performed during residents’ first semester of training in phacoemulsification (Level 1 – L1), surgeries performed during the second semester (Level 2 – L2), and surgeries performed during the third semester (Level 3 – L3). The primary outcome was the incidence of intraoperative complications in each group. Secondary outcomes were the comparisons between initial and final corrected distance visual acuity (CDVA), intraocular pressure (IOP), endothelial cell density (ECD), and central corneal thickness (CCT) in each group. Descriptive statistical analyses were employed in the presentation of the results using central tendency and variance measurements.ResultsThe rate of complications within six weeks of follow-up was 24 out of 102 eyes (23.53%) in the L1 group, 63 out of 301 eyes (20.93%) in the L2 group, and 37 out of 327 (11.31%) in the L3 group (p=0.001). Posterior capsule rupture (PCR) was the most frequent intercurrence observed in all three semesters: it occurred in 12.7% of the surgeries in the first semester (13/102), 16.9% of surgeries in the second semester (51/301), and 9.5% of surgeries in the third semester (31/327). There was no significant difference in CDVA (p=0.298), ECD (p=0.067), IOP (p=0.217), or CCT (p=0.807) between the groups.ConclusionWhen measured by rates of complications and by the aforementioned parameters, surgical competency was found to improve as surgical experience and frequency increased. Therefore, this study identified some patterns of skill development that can be applied to teaching strategies and better assist surgeons in training.

Effect of full-time vs volunteer faculty supervision on resident cataract surgery complications.

To examine the effect of teaching experience of supervising surgeons on resident cataract surgery intraoperative complication rates. Zuckerberg San Francisco General Hospital, University of California San Francisco, USA. Retrospective chart review. Cataract surgeries performed by University of California San Francisco (UCSF) ophthalmology residents from 2010 to 2017 were reviewed. Only cases supervised by anterior segment attendings with more than 10 years of postresidency surgical experience were included. Cases were categorized as being supervised by either full-time UCSF teaching attendings or volunteer private practice attendings. Cases were graded as low risk (0 risk factors), intermediate risk (1 risk factor), or high risk (≥2 risk factors) based on 8 preoperative and intraoperative risk factors. Complication rates were compared between the 2 attending groups among varying risk grades. Of 1377 cases, 101 developed complications. Among low-risk cases, full-time teaching attendings (25/619 [4.04%]) had a similar complication rate to volunteer attendings (17/387 [4.39%]) (odds ratio [OR] 0.92; P = .79). In intermediate-risk cases, full-time teaching attendings (28/195 [14.36%]) had slightly worse complication rates than volunteer attendings (10/88 [11.36%]) (OR 1.63; P = .45). High-risk cases had the highest complication rates, with the complication rates of full-time teaching attendings (16/72 [22.22%]) somewhat lower than those of volunteer attendings (5/16 [31.25%]) (OR 0.64; P = .48). For low-risk resident-performed cataract surgeries, supervision by full-time faculty and volunteer attendings yielded similar complication rates; thus, residency programs might safely recruit volunteer attendings to supervise low-risk cataract surgeries to support resident training. The analysis of higher-risk cases was limited by a low surgical volume.

Learning Curve of a Surgical Educator: Resident Cataract Surgery Outcomes under the Supervision of One Attending Surgeon over 5 Years

Abstract Background The main purpose of this article is to determine the trend of intraoperative complications of resident-performed cataract surgery under the supervision of one attending surgeon during the initial 5 years of surgical teaching. Methods A retrospective chart review was conducted at the Wilmer Eye Institute for all postgraduate year 4 resident-performed cataract surgeries between July 2013 and June 2018 that were supervised by one attending surgeon who was directly out of fellowship training. Recorded data included patient demographics, presence of preoperative risk factors (small pupil, dense cataract, history of ocular trauma, pseudoexfoliation syndrome, postvitrectomy, pre-existing zonular weakness, and high myopia), and intraoperative complications (posterior capsule tear resulting in vitreous loss and zonular dehiscence resulting in vitreous loss and/or loss of sulcus support). A generalized estimating equation model was constructed to determine factors associated with intraoperative complications. Results A total of 1,253 resident cataract surgeries involving 988 patients were included. The overall complication rate was 3.6% (n = 45/1253), with a decreasing trend observed in the rate of intraoperative complications across the study years. Multivariate analysis found that complications during cataract surgery were more likely to occur in earlier years of the supervising surgeon's career (p = 0.01), at the beginning of the academic year (p = 0.03), in eyes with preoperative risk factors (p &lt; 0.001), black patients (p = 0.02), and left eyes (p = 0.02). Conclusion A learning curve exists for novice attending surgeons during their initial years of resident cataract surgery supervision. Residency programs should consider resources to educate novice surgical educators, especially on how to effectively supervise resident-performed complex cases.

National survey and outcomes of resident-performed cataract surgery in monocular patients in the United States

To identify nationwide policies surrounding cataract surgery in monocular patients and compare outcomes of those surgeries between residents and attending surgeons. Wilmer Eye Institute, Baltimore, Maryland, USA. Retrospective case series. Cataract surgery educators across the United States were surveyed on their policies concerning residents performing cataract surgery on monocular patients. A second survey assessed resident opinions on performing surgery in such patients. In addition, a retrospective chart review was performed of all monocular patients (n=72) who had resident-performed and attending-performed cataract surgery at the same academic institution. Forty-seven residency programs responded to the survey. Although the majority of cataract surgery educators from these programs thought it was ethical for residents to perform cataract surgery on monocular patients, only 18 programs (38.3%) had implemented specific policies. The resident survey response rate was 39.1%. Residents were more anxious and did more preparation for monocular cases than for routine cataract surgery cases. Analysis of the comparative case series found intraoperative complications (9.7% versus 5.6%; P=.37) and postoperative visual outcomes were comparable between resident and attending surgeon monocular cases. The resident status of the surgeon was not predictive of an increased risk for complications (odds ratio, 0.98; 95% confidence interval, 0.13-7.55; P=.99). Although most educators and resident trainees deemed resident-performed cataract surgery on monocular patients to be acceptable, the majority of residency programs did not have specific guidelines for residents performing surgery on such patients. Outcomes of resident-performed cataract surgeries on monocular patients at the same institution were comparable to surgeries performed by attending surgeons.

Wet Lab-Based Cataract Surgery Training Curriculum for the PGY 2/PGY 3 Ophthalmology Resident.

Studies have shown that structured cataract surgery training curricula are beneficial for resident surgeons-in-training, yet nearly one-third of US training programs do not have one, and public dissemination of said curricula are lacking. We created a microsurgical simulation center and accompanying structured training curriculum. Weekly lectures focused on the steps of cataract surgery, variations on technique, and complications. Each didactic was followed by a 1.5- to 2-hour time block with faculty supervision in the wet lab. Finally, to demonstrate proficiency, residents submitted a recorded video illustrating their competency within 1 week of the lecture. We reviewed videos and provided written feedback via a standardized form. Curriculum effectiveness was evaluated through formative feedback on the course itself and complication rates for resident-performed cataract surgery before and after implementation of the curriculum. The course was implemented in 4 consecutive academic years, allowing time for nine junior residents to participate in the course at least once before operating as a senior. The incidence of posterior capsule tears for senior residents decreased from 3.07% in the 4 years preceding curriculum implementation to 1.13% for the senior residents who completed the course at least once as juniors (p = .0571). Supervised wet lab sessions and submitted videos allowed faculty to identify surgically struggling residents early. Implementation of a cataract surgery training curriculum for junior ophthalmology residents provides a safe and effective environment to practice surgical techniques. Such a curriculum may decrease the complication rates of beginner surgeons.

Outcomes in resident-performed cataract surgeries with iris challenges: Results from the Perioperative Care for Intraocular Lens study

To assess the outcomes of resident-performed cataract surgeries with iris challenges and to compare these outcomes with similar surgeries performed by attending surgeons. Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA. Retrospective chart review. All cases of cataract extraction by phacoemulsification with intraocular lens implantation, performed by comprehensive ophthalmologists between January 1 and December 31, 2014, were reviewed. Cases with preoperative or intraoperative miosis, iris prolapse, and intraoperative floppy iris syndrome, were included for analysis. Visual outcomes and the rate of perioperative adverse events were compared between resident and attending surgeon cases. Factors predicting adverse events were also assessed. In total, 1931 eye cases of 1434 patients were reviewed, and 65 resident cases and 168 attending surgeon cases were included. The mean logarithm of the minimum angle of resolution corrected distance visual acuity was better in the resident group1month after surgery (0.051±0.10 [SD] versus 0.132±0.30, P=.03); however, the difference was eliminated when controlling for macular disease. The mean operative time was 43.8±26.5minutes and 30.9±12.6minutes for cases performed by resident surgeons and attending surgeons, respectively (P.0001). Residents utilized supplemental pharmacologic dilation or retraction more frequently than attending surgeons (98% versus 87% of cases, P=.008). The overall rate of adverse events was no different between residents and attending surgeons (P=0.16). Dense nuclear sclerosis predicted adverse events in cataract cases with iris challenges (adjusted odds ratio, 1.86; 95% confidence interval, 1.17-2.94; P=.001). Although requiring longer operative times and more surgical manipulation, residents who performed cataract surgeries with iris challenges achieved outcomes comparable to those performed by attending surgeons, and residents should be given the opportunity to operate on these eyes.

Femtosecond-Assisted Cataract Surgery in Residency Training

Exposure to femtosecond laser-assisted cataract surgery (FLACS) in resident education is varied and limited to a few programs at this time. Although literature has been published on FLACS in experienced surgeons, there has been limited data on FLACS in resident-performed cataract surgery. Current literature in resident-performed surgery suggests less phacoemulsification energy; however, the data on outcomes and operative time are varied. Additional studies are needed to determine the benefits of FLACS in resident education. Regardless of the results, even minimal exposure to new technology for surgeons in training is beneficial if easily accessible by the residency program.

A Comprehensive Surgical Curriculum Reduced Intra-operative Complication Rates of Resident-performed Cataract Surgeries

To evaluate the impact of a comprehensive cataract surgery curriculum on the incidence of intraoperative complications. We retrospectively compared the total number of cataract surgeries that the residents performed in all of the teaching sites, and the incidences of intraoperative complications (anterior capsule tear, posterior capsule rent, vitreous loss, anterior vitrectomy, zonular dialysis, iris trauma, hemorrhage, dropped lens fragment, corneal wound burn, incorrect intraocular lens) for the surgeries performed at Massachusetts Eye & Ear by residents in the pre-intervention group (residents graduating in 2004 and 2005), before the implementation of a surgical curriculum, and the residents in the post-intervention group (residents graduating in 2014 and 2015). Ophthalmology residency program at a major academic institution. Residents graduating in 2004, 2005, 2014, and 2015. We reviewed 4373 charts. 2086 of those surgeries were performed at Massachusetts Eye & Ear. The incidence of posterior capsule rent/vitreous loss/anterior vitrectomy was lower in the post-intervention group (1.4% versus 7.7%, p<0.0001). Other complications were also lower in the post-intervention group. Implementation of a comprehensive cataract surgery curriculum focusing on pre-operative, intra-operative and post-operative interventions, with an emphasis on patient outcomes resulted in a decrease in the rate of intraoperative complications.

Complication rates of resident-performed cataract surgery: Impact of early introduction of cataract surgery training

To determine the effect of the early introduction of cataract surgery training on the complication rates of resident-performed cataract surgery. University of California San Diego, San Diego, California, USA. Retrospective case series. Two classes of ophthalmology residents were examined, one class with a late introduction of cataract surgery and one with an early introduction of cataract surgery. All cataract cases in which residents acted as primary surgeon were included. Patient charts were reviewed to collect data on patient characteristics, surgical details, and intraoperative and postoperative complications. The late-introduction cohort comprised 3 residents who performed 540 cataract cases, all during their final year of residency. The early-introduction cohort comprised 4 residents who performed 780 cataract cases beginning in the first year of residency. The late-introduction cohort had higher rates of major intraoperative complications than the early-introduction cohort (8.5% versus 3.1%) and of anterior vitrectomy (7.6% versus 2.1%) (both P<.001). Examination of the anterior vitrectomy rate as a function of experience showed the early-introduction cohort had a stable anterior vitrectomy rate of 1% to 2% throughout training, while the late-introduction cohort had a peak anterior vitrectomy rate of 12% at approximately case 20. Multivariable regression analysis showed the early-introduction cohort was independently associated with a lower rate of anterior vitrectomy (hazard ratio, 0.49; 95% confidence interval, 0.36-0.66) after adjusting for differences in patient characteristics and surgical complexity. Early introduction of cataract surgery training significantly decreased the rate of major intraoperative complications, specifically anterior vitrectomy, in resident-performed cataract surgeries.

Etiology and treatment outcomes of persistent postoperative inflammation in primary resident-performed cataract surgeries at a large tertiary care public hospital

To determine the risk factors, intraoperative and postoperative complications, therapeutic interventions, and visual outcomes for persistent postoperative inflammation in primary resident-performed cataract surgeries. Ben Taub General Hospital, Houston, Texas, USA. Retrospective case series. Primary resident-performed cataract surgeries from January 2012 to June 2015 were analyzed for persistent postoperative inflammation, defined as persistent anterior chamber inflammatory reaction after a standard 1-month topical corticosteroid and nonsteroidal antiinflammatory drug (NSAID) drops taper. Preoperative characteristics, operative complications, therapeutic modalities, and duration of therapy were analyzed. The primary outcome measures were duration of corticosteroid and NSAID therapy, treatment modalities, and postoperative visual outcomes at the 1-month postoperative visit. The study assessed 1290 primary resident-performed cataract surgeries. Persistent postoperative inflammation occurred in 82 eyes (6.6%). The presumed etiology was classified as idiopathic persistent postoperative inflammation, nonadherence to topical therapy, and complicated cataract surgery. Patients with persistent postoperative inflammation were more likely of African American descent, had hypertension, or used aspirin, anticoagulants, or prostaglandins (P=.019, P=.027, P=.028, P=.020, respectively). The complicated cataract subgroup required a longer duration of therapy (P=.021) and was the only subgroup to require injections or systemic corticosteroids. There was no significant difference in postoperative corrected distance visual acuity (CDVA) when comparing patients with persistent postoperative inflammation with those without inflammation or between the subgroups. The idiopathic and nonadherent subgroups were successfully treated with topical antiinflammatory therapy; the complicated subgroup required longer duration and multiple modalities of treatment. Visual outcomes were comparable to the general cataract population with no differences in postoperative CDVA.

Improved utilization of operating room time for trainee cataract surgery in a public hospital setting

To examine the effect of group goal and group performance theories on operating room efficiency in resident-performed cataract surgery. Zuckerberg San Francisco General Hospital and Trauma Center, Department of Ophthalmology, University of California, San Francisco, California, USA. Prospective case series. This study assessed 4 specific segments of operating room utilization identified as room-to-incision time, incision-to-close time, close-to-exit time, and room turnover time. The time segments were measured for resident-performed cataract cases before the proposed intervention. Then, group goals were set for ideal times of each utilization segment. Behaviors of the surgery, anesthesia, nursing, pharmacy, and housekeeping teams that would improve group performance were identified. Utilization segments were measured again after the intervention. The time segments were measured for 134 resident-performed cataract cases before the proposed intervention and again after the intervention for 136 resident-performed cataract cases. Before the intervention, the mean overall case time was 55minutes, allowing for 10 cases in a 10-hour day. After the intervention, the mean overall case time was 46minutes, allowing for 13 cases in a 10-hour day. The decrease in postintervention times for overall case time, room-to-incision time, and close-to-exit time were statistically significant. Operating room utilization for resident-performed cataract surgery was enhanced by setting group goals. A multidisciplinary effort to enhance group performance through behavior modification can be implemented immediately and improve efficiency without compromising patient safety or resident teaching.

Effect of wet-laboratory training on resident-performed manual small-incision cataract surgery.

Effect of wet-laboratory training on resident-performed manual small-incision cataract surgery.

Cataract Surgery Cancellations: An Analysis of Financial and Resident Training Implications at a Major Eye Institution

Purpose The objective of this study was to assess reasons for cancellation of resident-performed cataract surgery, identify modifiable barriers to completion of the surgery on the scheduled date, and analyze the healthcare reimbursements and educational experiences lost as a result of cancellations. Setting General eye clinic staffed by residents in a major urban center. Design Retrospective, observational study. Methods The study compared patients (older than 18 years) who canceled their cataract surgery to patients who underwent surgery on their scheduled date. Cancellation and reimbursement information was obtained from the surgical coordinator's scheduling book and billing information. Demographic information was obtained from patient electronic medical records, and scheduling logs. A brief phone survey was implemented to identify patient's barriers to surgery if a reason for cancellation was undocumented. Results The overall cancellation rate over 1-year was 29.54% and most common overall reason for cancellation was that preadmission testing (PAT) was not completed in time for the procedure. Overall, 72% of the cancellations were made within 7 days of the surgery. The total estimated lost potential reimbursement due to cancellation was $844,370. The relative loss of surgical opportunities for residents throughout this 1-year period was 230 cases or 29 surgeries per resident. Conclusion These findings have prompted a new study testing whether on-site mandatory PATs conducted on the same day as the patient's ophthalmology evaluation will reduce cataract surgery cancellation rates.

Outcomes and complication rates of primary resident-performed cataract surgeries at a large tertiary-care county hospital

To identify the preoperative risk factors, intraoperative events, and postoperative complications increasing the risk for poor visual outcomes in resident-performed cataract surgeries at a tertiary-care county hospital. Ben Taub General Hospital, Houston, Texas, USA. Retrospective case series. Resident-performed cataract surgeries were analyzed for risk factors, comorbidities, and intraoperative and postoperative complications. The main outcome measures were preoperative and postoperative uncorrected distance visual acuity and corrected distance visual acuity (CDVA), which were correlated with preoperative demographics, intraoperative and postoperative events, and resident training level. The data were subdivided into cases without events and cases with events to determine which complications led to poor visual outcomes. The study analyzed 1290 resident-performed cataract surgeries. The mean visual acuity improved significantly after surgery in all patients (P<.001), with 80.5% of patients without complications and 70.7% with complications attaining a CDVA of 20/40 or better (P<.002). Poor visual outcomes were associated with α-antagonist use (P=.043) and pseudoexfoliation syndrome (P=.001). The most common intraoperative complications were vitreous loss (6.7%) and posterior capsule tear (7.0%). The mean postoperative visual acuity did not vary by trainee year, and the rate of dropped nucleus during surgery declined as residents progressed in training (P<.05). All other complication rates were similar between levels of training. Despite more complicated cataracts and advanced comorbidities, primary resident-performed cataract surgery in a tertiary-care county hospital system achieved visual outcomes and complication rates similar to those found in other training hospitals.