Impact of a Preoperative Risk Stratification System on Complication Rates During Resident-Performed Cataract Surgery

Several risk stratification systems against intraoperative complications of phacoemulsification cataract surgery have been empirically validated as to their usefulness in clinical settings, yet it remains unclear whether their application is making a notable difference in the training of resident surgeons in clinical practice. The purpose of this study is to compare practice-as-usual in assignment of training cases to residents versus the application of a statistically validated risk classification system.

This cross-sectional observational study included patients who underwent phacoemulsification surgery by residents in training, divided into two groups of 440 and 452 patients. The first group of patients had been assigned to residents following practice-as-usual while the second group followed the assessment with a validated risk stratification system.

Although residents were assigned patients who were considered less prone to complications even before the introduction of a consistent risk stratification system, the difference in the assignment of riskier cases was statistically significant (p = 0.002). The reduction in the assignment of riskier cases was associated with fewer complications (64 complications/440 eyes versus 33/452, p = 0.004).

The introduction of a risk stratification system correlated with fewer interoperative complications and less challenging cases assigned to residents.