Surgical Outcomes and Cost Basis for Resident-Performed Cataract Surgery in an Uninsured Patient Population

Abstract

IMPORTANCEIn the past, resident physicians have provided care to indigent patients under the supervision of experienced physicians. General consensus exists regarding higher surgical costs of patient care at teaching hospitals. No study has examined the outcomes or the cost basis for resident physicians providing health care to an underserved population.OBJECTIVES To evaluate the visual results in uninsured patients undergoing cataract surgery performed by resident surgeons at a single institution and to determine the cost-effectiveness of care. DESIGN AND SETTINGA retrospective case series of consecutive uninsured patients undergoing cataract procedures performed by attending-supervised resident physicians at the University of Washington from July 1, 2005, through June 30, 2011. Data obtained included demographic information, preoperative and postoperative best-corrected visual acuity (BCVA) in the eye undergoing the procedure, and surgical complications. We calculated the costs of services rendered and normalized them to 2011 dollars. These data were incorporated into time-trade-off discounted utility values. Data were expressed as mean (SD).PARTICIPANTS One hundred forty-three consecutive patients. EXPOSURE Cataract surgical procedures. MAIN OUTCOMES AND MEASURES Costs of the surgical procedure and the utility value associated with the BCVA in the operated-on eye, RESULTS The mean logMAR preoperative BCVA was 1.09 (0.74) (Snellen equivalent, 20/300). The best-recorded mean postoperative BCVA was 0.24 (0.42) (Snellen equivalent, 20/40), obtained at 3.77 (9.30) months. The final recorded mean BCVA was 0.27 (0.43) (Snellen equivalent, 20/40), obtained at a median (SD) follow-up of 16.32 (17.10) months. Four complications in 3 eyes required a second operation; 15 postoperative laser procedures were performed. The mean health care cost per patient was $3437.24 ($1334.68). Using these data, the mean utility value of cataract surgery in this population was 0.80 (0.12); the quality-adjusted life-years gained, 2.43 (1.87); and the discounted ratio of cost to utility, $1889.16 ($4800.62).CONCLUSIONS AND RELEVANCE These data support the success and cost-effectiveness of supervised, resident-performed cataract surgery in an underserved patient population. This study lends support for continuing this traditional scheme of surgical training and education. Further work must ensure that we remain aware of the balance between education and patient care.

Visual outcome of cataract surgery in a tertiary care teaching hospital

“…[18][19][20][21] So, for the betterment of surgical outcomes, audit and re audit should be conducted. [22][23][24][25] Postoperative VA was recorded for 982 (100%) eyes. After cataract surgery, 966 (98.4%) eyes had good VA compared with pre-operative measurements.…”

Nursing opinions on collaborating with residents in new and legacy OB/GYN programs

“…Additionally, Smith et al Studies have demonstrated that resident involvement can improve cost-effective medical care without changing patient care outcomes. 12 Similarly, positive resident-nurse interactions can improve patient safety, quality of care, provider and nurse satisfaction and healthcare costs, which can be facilitated by increased availability and receptiveness to communication. 13,1 The resident-nurse relationship is impacted uniquely in different specialties.…”

Visual and anatomic outcomes of cataract surgery with intraoperative or postoperative complications in a teaching institution

“…3 Several published studies report on the rates of intraoperative and postoperative complications in resident-performed surgeries, however few report on visual and especially anatomic outcomes. [3][4][5] Making use of department-maintained morbidity and mortality records as well as visual acuity and OCT data, the purpose of the current study is to assess the visual and anatomic outcomes of resident-performed cataract extractions in cases with intraoperative or major postoperative complications.…”