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

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Abstract

Purpose

To evaluate the operative duration and clinical performance of ophthalmology residents performing standard phacoemulsification cataract surgeries using information available from electronic health records (EHR).

Methods

This is a retrospective cohort study. De-identified surgical records of all standard phacoemulsifications performed in a tertiary institution between 1st January 2015 and 8th August 2018 were retrieved from the hospital EHR. The main outcome measures were improvement in operative duration with case experience, corrected distance visual acuity (CDVA) improvement, and intra-operative complication rates.

Results

Twelve ophthalmology residents performed a total of 1427 standard phacoemulsifications. The median operative duration was 27 min (interquartile range, 22–34 min), which improved from 31 to 24 min (before the 101st case [Group 1] versus 101st case onwards [Group 2], p < 0.001). Gradient change analysis (non-linear regression) showed significant reduction until the 100th case (p = 0.043). Older patients (0.019), worse pre-operative CDVA (0.343), and surgery performed by Group 1 (1.115) were significantly associated with operative duration above 30 min. LogMAR CDVA improved from a mean of 0.57 ± 0.52 pre-operatively to 0.10 ± 0.18 post-operatively (p < 0.001). Posterior capsule rupture (PCR) rate decreased from 4.0% [Group 1] to 2.1% [Group 2] (p = 0.096), while overall complication rate decreased from 8.9% to 3.1% (p < 0.001).

Conclusion

The median operative duration reduced consistently with surgical experience for the first 100 cases. Older patients, poorer pre-operative VA, and surgical experience of less than 100 cases were significantly associated with an operative duration above 30 min. There was a statistically significant decrease in complication rate between Group 1 and 2.

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Authors and Affiliations

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

    Darren Ngiap Hao Tan, Marcus Tan, Hariz Liew & David Z. Chen

  2. Biostatistics Unit, Yong Loo Lin School of Medicine, Singapore, Singapore

    Liang Shen

  3. Division of General Surgery (Endocrine and Thyroid Surgery), Department of Surgery, National University Hospital, Singapore, Singapore

    Kee Yuan Ngiam

Authors
  1. Darren Ngiap Hao Tan
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  2. Marcus Tan
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  3. Hariz Liew
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  4. Liang Shen
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  5. Kee Yuan Ngiam
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  6. David Z. Chen
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Contributions

D.N.H.T. wrote the main manuscript. D.N.H.T., H.L.Z.W., and L.S. contributed to the data retrieval and data analysis. D.N.H.T. and D.Z.C. prepared figures 1-2 and tables 1-3. M.T., D.Z.C., and N.K.Y. contributed to the study design and the subsequent revisions. All authors reviewed the manuscript.

Corresponding author

Correspondence to David Z. Chen.

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Conflict of interest

No government and non-government support were received for this study. The authors have no relevant financial or non-financial interests to disclosure.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Review Board—National Health Group Domain Specific Review Board—prior to study initiation.

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Tan, D.N.H., Tan, M., Liew, H. et al. A data-driven approach to evaluate factors affecting resident performance in cataract surgery. Int Ophthalmol 43, 3269–3277 (2023). https://doi.org/10.1007/s10792-023-02730-1

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  • DOI: https://doi.org/10.1007/s10792-023-02730-1

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