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Comparing Surgical Outcomes Before and After Instituting a New Ophthalmology Residency Program at a Veterans Affairs
Emily S Levine1, Donald M Miller1, Michael E Zegans1
1Section of Ophthalmology, Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH 03756, United States.
Introduction:
To compare cataract surgical outcomes and rates of complications between attending-led and resident-led surgical cases before and after the introduction of senior Dartmouth ophthalmology residents into the operating room at the White River Junction Veterans Affairs Medical Center (WRJ VA) in 2023.
Materials And Methods:
Preoperative patient factors, intraoperative metrics, and postoperative outcomes of patients who underwent eye surgery between July 1, 2022 and June 30, 2024 were recorded. Statistics were run to compare the 2022-2023 year (year 1) with a single attending surgeon to the 2023-2024 year (year 2) with the addition of 2 senior residents. Statistical tests also compared metrics and outcomes between the 3 surgeons in year 2.
Results:
There was no significant difference in intraoperative complications or visual outcomes with the addition of residents as primary surgeons. Resident-led cases were longer on average, but the overall number of surgeries performed did not decrease with the addition of residents. The attending tended to do more of the cases in which the patient exhibited preoperative factors that could potentially contribute to complication or reduce visual outcomes, but there was no difference in intraoperative metrics across the 3 surgeons.
Conclusions:
Introducing resident training into a surgical service is safe and does not reduce the quality of patient outcomes. These findings support the WRJ VA-Dartmouth partnership as a model for implementing supervised resident surgical education and highlight how VA-based training environments can simultaneously advance high-quality veteran care and graduate medical education.
