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A data-driven approach to evaluate factors affecting resident performance in cataract surgery.

Darren Ngiap Hao Tan1, Marcus Tan1, Hariz Liew1

  • 1Department of Ophthalmology, National University Hospital, Level 7, 1E Kent Ridge Road, Singapore, 119228, Singapore.

International Ophthalmology
|May 9, 2023
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Summary

Ophthalmology residents performing cataract surgery significantly reduced operative duration within their first 100 cases. Experience also lowered complication rates, demonstrating improved clinical performance with surgical volume.

Keywords:
Cataract surgeryComplication rateOperative durationPhacoemulsificationSurgery outcomes

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Area of Science:

  • Ophthalmology
  • Surgical Education
  • Health Informatics

Background:

  • Standard phacoemulsification cataract surgery is a core procedure in ophthalmology training.
  • Evaluating resident performance is crucial for surgical education and patient safety.
  • Electronic health records (EHR) offer a valuable resource for retrospective analysis of surgical outcomes.

Purpose of the Study:

  • To assess the learning curve for ophthalmology residents performing standard phacoemulsification cataract surgery.
  • To evaluate the impact of surgical experience on operative duration and clinical outcomes.
  • To identify factors associated with prolonged operative times in resident-performed cataract surgery.

Main Methods:

  • Retrospective cohort study utilizing de-identified EHR data from a tertiary institution.
  • Analysis of 1427 standard phacoemulsification surgeries performed between January 2015 and August 2018.
  • Primary outcomes included operative duration, corrected distance visual acuity (CDVA) improvement, and intra-operative complication rates.

Main Results:

  • Median operative duration decreased from 31 to 24 minutes as residents gained experience (p < 0.001), with significant improvement up to the 100th case.
  • Older patients, worse pre-operative CDVA, and fewer than 100 cases were associated with operative durations exceeding 30 minutes.
  • Post-operative CDVA improved significantly (p < 0.001), and overall complication rates decreased from 8.9% to 3.1% (p < 0.001).

Conclusions:

  • Resident operative duration for cataract surgery shows a significant learning curve, particularly within the first 100 cases.
  • Factors such as patient age and pre-operative visual acuity influence operative time.
  • Increased surgical experience is associated with reduced complication rates, enhancing patient safety.