Maximising safety of cataract surgery training: improving patient safety by reducing cataract surgery complication...

Cataract surgery is a highly successful, high-volume surgery, hence reducing surgical complications are imperative for organizations to deliver cost-effective, high-quality services that meet the needs of patients. This paper aims to describe 18-month results of a sustainable program to maximize the safety of cataract surgery training.

Modifications to the comprehensive cataract-training program and tested were developed in a controlled, interventional case series to evaluate their effect on trainee complication rates. Data collection and interpretation were performed in a prospective and blind manner.

Prior to intervention, PCR rates for trainee-surgeons averaged 3.34 per cent cf international published figures of 4.6-10 per cent. This compared with 1.89 per cent PCR rate for trained cataract surgeons (p < 0.002, Mann Whitney test). Multiple interventions were introduced and enforced to maximize cataract surgery training safety. After 18 months follow-up data were consistent with a statistically significant reduction in trainee PCR rates (1.53 per cent, p < 0.007, Wilcoxon Signed Ranks test) compared with trained cataract surgeons (1.23 per cent, p < 0.074, Wilcoxon Signed Ranks test). Parameters of training efficacy were improved or maintained during this period.

Limitations included using trained cataract surgeons as controls as apposed to a similar group of trainee surgeons. In addition, multiple interventions were simultaneously instituted, making identification of a single influential factor impossible to identify.

Maximally safe and effective cataract surgery training is achieved in Singapore without compromising service and quality markers. Similar training goals can be extrapolated to other surgical disciplines.

This is the first study to demonstrate maximally safe and effective cataract surgery training in a large patient group, over sustained periods.