Efficacy of Preoperative Risk Stratification on Resident Phacoemulsification Surgeries

Omar Moussa; Tahvi Frank; Ives A Valenzuela; Joah Aliancy; Dan Gong; Joaquin O De Rojas; Lora R Dagi Glass; Bryan J Winn; George A Cioffi; Royce W S Chen

doi:10.2147/OPTH.S368633

Efficacy of Preoperative Risk Stratification on Resident Phacoemulsification Surgeries

Clin Ophthalmol. 2022 Jul 1:16:2137-2144. doi: 10.2147/OPTH.S368633. eCollection 2022.

Authors

Affiliations

¹ Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA.
² Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
³ Department of Ophthalmology, Retina Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA.
⁴ Center for Sight, Sarasota, FL, USA.
⁵ Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA.

Abstract

Purpose: To evaluate efficacy of a novel risk stratification system in minimizing resident surgical complications and to evaluate whether the system could be used to safely introduce cataract surgery to earlier levels of training.

Materials and methods: This is a retrospective cross-sectional study on 530 non-consecutive cataract cases performed by residents at Columbia University. Risk scores, preoperative best corrected visual acuity (BCVA), intraoperative complications, postoperative day 1 (POD1), and month 1 (POM1) exam findings were tabulated. The relationship between risk scores and POD1 and POM1 BCVA was modeled using linear regression. The relationship between risk scores and complication rates was modeled using logistic regression. Logistic regression was used to model the rates of complications across different levels of training. Rates of complications were compared between diabetic versus non-diabetic patients using t-tests.

Results: Risk scores did not have significant association with intraoperative complications. Risk scores were predictive of corneal edema (OR = 1.36, p = 0.0032) and having any POM1 complication (OR = 1.20, p = 0.034). Risk scores were predictive of POD1 (β = 0.13, p < 0.0001) and POM1 (β = 0.057, p = 0.00048) visual acuity. There was no significant association between level of training and rates of intraoperative (p = 0.9) or postoperative complications (p = 0.06). Rates of intraoperative complication trended higher among diabetic patients but was not statistically significant (p = 0.2).

Conclusion: Higher risk scores were predictive of prolonged corneal edema but not risk of intraoperative complications. Our risk stratification system allowed us to safely introduce earlier phacoemulsification surgery.

Keywords: cataract; cataract risk stratification; resident phacoemulsification surgery.

Grants and funding

OM, TF, IAV, JA, DG, JOD, LRDG, BJW, GAC, and RWSC were supported by National Eye Institute Core Grant P30EY019007 and an unrestricted grant from Research to Prevent Blindness. The funding organization had no role in the design or conduct of this research.