Database evaluation of complication rates and visual outcomes of cataract surgery performed by trainees vs
Kaersti L Rickels1, Abdelrahman M Elhusseiny, Muhammad Z Chauhan
1From the Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences (UAMS) Medical Center, Little Rock, Arkansas (Rickels, Elhusseiny, Chauhan, Toma, Sallam); Department of Ophthalmology, Ain Shams University Hospitals, Cairo, Egypt (Toma); Department of Ophthalmology, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom (Ellabban); Department of Ophthalmology, Gloucestershire Hospitals NHS Trust, Gloucestershire, United Kingdom (Sallam).
Purpose:
To compare complication rates and visual outcomes of cataract surgery performed by trainees vs independent surgeons.
Setting:
8 UK clinical centers.
Design:
Retrospective multicenter clinical database study.
Methods:
15-year data of 35 558 cataract surgeries undertaken by trainees and 77 131 by independent surgeons were evaluated for the rate of operative complications with emphasis on posterior capsule rupture (PCR) and logMAR distance visual acuity (VA) (defined as best available value of uncorrected or corrected VA) at 4 to 12 weeks. Recording of intraoperative complications was robust using a predetermined list of cataract surgery complications in the electronic medical record.
Results:
Trainees operated on less complex eyes, with lower rates of advanced cataracts and poor pupillary dilation ( P < .001). Trainee surgeries had a significantly higher rate of PCR (2.4% vs 1.3%) compared with independent surgeons. Junior trainees had the highest PCR rate at 3.87%, compared with senior trainees at 2.12%. Using the funnel plot methodology, most surgeons seemed to approach the overall mean of PCR, 1.9%, at a surgical volume of approximately 150 cases. At 4 to 12 weeks postoperatively, there was no significant difference in the mean logMAR VA between both groups (0.197 vs 0.200, Snellen equivalent ∼20/30, P = .095).
Conclusions:
PCR should be the primary metric for assessing the quality of trainee-performed cataract surgery rather than VA outcomes. Funnel plot representation of PCR provides an equitable approach for monitoring trainees' surgical progress and peer-to-peer comparisons.
