Affiliation:
1. Hadassah Medical Center
2. Hadassah Academic College
3. Hadassah Academic College, Hadassah Medical Center
Abstract
Abstract
Introduction
This retrospective study explores the connection between preoperative patient risk factors, the experience of ophthalmology residents, and the outcomes of cataract surgeries conducted at Hadassah Medical Center. It is hypothesized that with increased experience, residents may demonstrate greater proficiency in handling surgeries on higher-risk patients, potentially leading to improved surgical outcomes overall.
Methods
Data from 691 consecutive cataract surgeries conducted by Ophthalmology residents at Hadassah Medical Center (1.2018–2.2022) were examined. Demographics, surgeon experience, and preoperative cataract risk assessment score, and pre- and post-operative best-corrected visual acuity (BCVA) were analyzed. The risk score was based on cataract density, previous vitrectomy, presence of phacodonesis, small pupil, extreme axial length (> 30mm or < 21.5mm) or abnormal axial length (26-30mm), shallow anterior chamber (< 2.5 mm), poor patient cooperation, oral alpha-1 blocker use, diabetic retinopathy (DR), and Fuchs' endothelial dystrophy, and having one functioning eye. This study focused on the correlation of risk scores with residents' surgical experience, and surgical outcomes.
Results
As residents gained experience, surgeries on patients with at least one risk factor increased from 54% (1st year) to 75% (2nd year; p < 0.001) and fluctuated between 75%, 82%, and 77% (3rd, 4th, and 5th years, respectively), with initial pre-operative BCVA declining progressively. Despite handling more complex cases over time, the percentage number of intraoperative complications per patient decreased with each year of residents' experience (17%, 13%, 11%, 17%, 6%; respectively). Patients without any risk factor had a higher post-operative BCVA compared those with one or more risk factors (mean ± SD LogMAR,0.16 ± 0.26 vs. 0.27 ± 0.35; p < 0.001) and a higher BCVA percentage of improvement (63% vs 57%, p = 0.016).
Conclusions
Using a preoperative risk assessment scoring system to allocate surgeries to residents at varying experience levels may reduce the risk for surgical complications, thereby, ensuring patient safety, and providing residents with a gradual learning experience.
Publisher
Research Square Platform LLC
Reference36 articles.
1. Rossi T, Romano MR, Iannetta D, Romano V, Gualdi L, D’Agostino I et al (2021) Original research: Cataract surgery practice patterns worldwide: a survey. BMJ Open Ophthalmol [Internet]. [cited 2023 Nov 24];6(1):e000464. Available from: /pmc/articles/PMC7812090/
2. Kauh CY, Blachley TS, Lichter PR, Lee PP, Stein JD (2016) Geographic variation in the rate and timing of cataract surgery among US communities. JAMA Ophthalmol [Internet]. Mar 1 [cited 2023 Mar 18];134(3):267–76. Available from: https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2478537
3. Gower EW, Lindsley K, Tulenko SE, Nanji AA, Leyngold I, Mcdonnell PJ Perioperative antibiotics for prevention of acute endophthalmitis after cataract surgery. Cochrane database Syst Rev [Internet]. 2017 Feb 13 [cited 2023 Mar 18];2(2). Available from: https://pubmed.ncbi.nlm.nih.gov/28192644/
4. Raczyńska D, Glasner L, Serkies-Minuth E, Wujtewicz MA, Mitrosz K Eye surgery in the elderly. Clin Interv Aging [Internet]. 2016 Apr 5 [cited 2023 Mar 18];11:407–17. Available from: https://pubmed.ncbi.nlm.nih.gov/27103794/
5. Payal AR, Gonzalez-Gonzalez LA, Chen X, Cakiner-Egilmez T, Chomsky A, Baze E et al (2016) Outcomes of cataract surgery with residents as primary surgeons in the Veterans Affairs Healthcare System. J Cataract Refract Surg [Internet]. ;42(3):370–84. http://dx.doi.org/10.1016/j.jcrs.2015.11.041