Incidence of and risk factors for vitreous loss in resident-performed phacoemulsification surgery

Hashemi, Hassan; Mohammadpour, Mehrdad; Jabbarvand, Mahmoud; Nezamdoost, Zahra; Ghadimi, Hadi

doi:10.1016/j.jcrs.2013.03.028

Cited by 56 publications

(43 citation statements)

References 12 publications

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“…Research on individual complications is more limited, with studies tending to concentrate on intraoperative complications, such as posterior capsule tear[13, 24, 25, 36–38] and intraoperative floppy iris syndrome (IFIS). [39–43] Postoperative endophthalmitis and retinal tear/detachment are also well-studied[16, 28, 44–49]—and our analysis also found complex cataract surgery to be associated with higher risk for endophthalmitis—however, other post-operative complications have been less extensively described in the literature.…”

Section: Discussionmentioning

confidence: 99%

Predictive Modeling of Risk Factors and Complications of Cataract Surgery

Gaskin

Pershing

Cole

et al. 2015

European Journal of Ophthalmology

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Purpose To quantify the relationship between aggregated preoperative risk factors and cataract surgery complications, as well as to build a model predicting outcomes on an individual-level—given a constellation of demographic, baseline, preoperative, and intraoperative patient characteristics. Setting Stanford Hospital and Clinics between 1994 and 2013. Design Retrospective cohort study Methods Patients age 40 or older who received cataract surgery between 1994 and 2013. Risk factors, complications, and demographic information were extracted from the Electronic Health Record (EHR), based on International Classification of Diseases, 9th edition (ICD-9) codes, Current Procedural Terminology (CPT) codes, drug prescription information, and text data mining using natural language processing. We used a bootstrapped least absolute shrinkage and selection operator (LASSO) model to identify highly-predictive variables. We built random forest classifiers for each complication to create predictive models. Results Our data corroborated existing literature on postoperative complications—including the association of intraoperative complications, complex cataract surgery, black race, and/or prior eye surgery with an increased risk of any postoperative complications. We also found a number of other, less well-described risk factors, including systemic diabetes mellitus, young age (<60 years old), and hyperopia as risk factors for complex cataract surgery and intra- and post-operative complications. Our predictive models based on aggregated outperformed existing published models. Conclusions The constellations of risk factors and complications described here can guide new avenues of research and provide specific, personalized risk assessment for a patient considering cataract surgery. The predictive capacity of our models can enable risk stratification of patients, which has utility as a teaching tool as well as informing quality/value-based reimbursements.

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Section: Discussionmentioning

confidence: 99%

Predictive Modeling of Risk Factors and Complications of Cataract Surgery

Gaskin

Pershing

Cole

et al. 2015

European Journal of Ophthalmology

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“…We found that the rate of hospitalization after surgery was significantly higher when operations were performed by residents, perhaps due to a higher prevalence of more severe complications. Although it has been shown that the quality of operations by residents, especially phacoemulsification surgery, is acceptable (29,30), complications such as vitreous loss (31)(32)(33) are more common; therefore, all patients should undergo a complete evaluation before surgery to prevent or reduce the incidence of complications (34,35).…”

Section: Discussionmentioning

confidence: 99%

Trends in outpatient cataract surgery in the Islamic Republic of Iran, 2006-2010

Hashemi

Fotouhi

Rezvan

et al. 2016

East Mediterr Health J

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This study aimed to determine the trends in outpatient cataract surgery and its determinants in the Islamic Republic of Iran between 2006 and 2010. In this cross-sectional study, 106 cataract surgery centres were selected in all provinces by multistage randomized cluster sampling. The number of centres in each province was determined from the number of cataract operations and the number of patient charts examined in each centre was proportionate to the number of cataract operations in that centre. The prevalence of outpatient surgery increased from 46.0% (95% CI, 35.3-56.8) in 2006 to 51.4% (95% CI, 40.2-62.7) in 2010 (P = 0.549). Patients stayed in hospital for more than one night after 10.5% (95% CI, 6.9-14.1) of operations. Use of phacoemulsification and topical anaesthesia increased the prevalence of outpatient surgery and decreased intraoperative complications. Although outpatient cataract surgery increased by 11.7%, use of methods such as phacoemulsification is not widespread, and more attention should be paid to the barriers to outpatient cataract surgery in the Islamic Republic of Iran. . Les patients sont restés plus d'une nuit à l'hôpital après 10,5 % (IC à 95 %, 6,9-14,1) des opérations. Le recours à la phaco-émulsification et l'anesthésie topique faisait augmenter la prévalence de la chirurgie ambulatoire et réduisait les complications intra-opératoires. Bien que la chirurgie de la cataracte en ambulatoire ait augmenté de 11,7 %, l'utilisation de méthodes telles que la phaco-émusification n'est pas répandue, et davantage d'attention devrait être apportée aux obstacles qui s'opposent à la chirurgie de la cataracte en ambulatoire en République islamique d'Iran. 2010-‫املتوسط‬ ‫لرشق‬ ‫الصحية‬ ‫املجلة‬ ‫العرشون‬ ‫و‬ ‫الثاين‬ ‫املجلد‬ ‫التاسع‬ ‫العدد‬ 677

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“…[11] They concluded that direct attending supervision and careful case selection for the level of cataract surgery residency were of utmost importance in avoiding sight-threatening complications. Pokroy et al, trying to determine whether virtual surgery simulator training improves actual resident cataract surgery performance, found that capsular tear rates for the non-simulator and simulator groups were 8.8% and 10%, respectively for the first 25 cases.…”

Section: P Valuementioning

confidence: 99%

“…[13] Several other studies showed lower complication rates in residents training programs varying from 3% to 7%. [9][10][11][12][13][14][15][16] …”

Section: P Valuementioning

confidence: 99%

Surgical Challenges Faced by Trainee Surgeons- A Prospective Comparative Study

Mushriff¹,

Telgote²,

Patel³

2017

jemds

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BACKGROUNDHuman resources like Doctors form the important part of all health systems. To achieve health objectives and goals, health resources should be distributed evenly among people irrespective of economic, social and geographical barriers. The aim of this study is to evaluate the surgical challenges faced by trainee Ophthalmologists and to compare the efficacy of two different methods of training; step-by-step method and one-step method are the two ways of training practiced to train ophthalmologists. This study compares the two ways of training by evaluating complications at the end of surgeries performed by trainee surgeons. Setting-Department of Ophthalmology, Index Medical College and Research Centre. Study Design-A Prospective Comparative Study. MATERIALS AND METHODSTime Period-1 st January 2017 to 31 st March 2017, 3 months. Cataract Surgery performed-Manual Small Incision Cataract Surgery performed within the above-mentioned period (80 SICS). Study was divided into 2 Groups accordinglyGroup 1-Including residents that were trained with the 'step-by-step' method (44 SICS). Group 2-Including residents that were trained with the 'one-step' method (36 SICS).1. Residents were evaluated for the ease of performing surgical steps. 2. Complications were recorded in terms of premature entry, buttonholing, running away of capsulorhexis, rhexis tear, zonular dialysis/dehiscence, posterior capsular rent/rupture, iridodialysis, vitreous loss. Both of the above-mentioned groups were compared according to various difficulties encountered in each approach and their management was done by the supervising surgeon. Patient was followed for 1 month. Data were listed and counted with Excel (Version 2007, Microsoft). Mean and Standard deviation was calculated. Chi-square and Student t-tests were used to assess statistical significance between groups. RESULTS 44 surgeries were done in "step-by-step" group of which 18 patients were male and 26 were female; and 36 surgeries were done in "one-step" group of which 20 were male and 16 were female. Mean age group of patient in "step-by-step" group was 64.22 ± 10.10 years and 63.50 ± 8.46 years in "one-step" group. Overall complication rate when compared between 2 groups were more in "onestep" group, which was significant in contrast to when individual complication rates were compared between two groups. CONCLUSIONThus to conclude, learning surgery is always an uphill task for a trainee. A great degree of temperament, practice and skills are required before proficiency is achieved. In our study, 2 approaches were practiced in learning SICS-"step-by-step" and "one-step"; and "step-by-step" approach was found beneficial for the beginners. KEYWORDS SICS, Trainee Surgeon, Cataract, Post-Operative Complication. HOW TO CITE THIS ARTICLE:Mushriff S, Telgote V, Patel K. Surgical challenges faced by trainee surgeons-a prospective comparative study.

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Incidence of and risk factors for vitreous loss in resident-performed phacoemulsification surgery

Abstract: Direct attending supervision and careful case selection for the level of cataract surgery residency are of utmost importance in avoiding sight-threatening complications.

Cited by 56 publications

References 12 publications

Predictive Modeling of Risk Factors and Complications of Cataract Surgery

Predictive Modeling of Risk Factors and Complications of Cataract Surgery

Trends in outpatient cataract surgery in the Islamic Republic of Iran, 2006-2010

Surgical Challenges Faced by Trainee Surgeons- A Prospective Comparative Study

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