Factors that positively affect the performance of residents during surgery are using a simulator preoperatively and maintaining a positive outlook.
The number of surgeries performed during residency training varies from institute to institute, and this can raise the question: How many surgeries are adequate to ensure patient safety and good outcomes after cataract surgery?
The complication rates associated with cataract surgeries performed by residents provide approximate information about the learning curve but not about the individual’s competency. The International Conference of Ophthalmology’s Ophthalmology Surgical Competency Assessment Rubric (ICO-OSCAR) facilitates an objective assessment of the surgical skills of a novice surgeon for performing a particular surgical task.
Rajesh Vedachalam, MBBS, highlighted the results obtained using the ICO-OSCAR in an analysis of the learning curve. Dr. Vedachalam, from the Department of Cornea, Aravind Eye Care, Puducherry, India, presented the study findings on behalf of Aravind Haripriya, MBBS.
Observation is key
Dr. Vedachalam pointed out that more manual small-incision cataract surgeries (MSICS) are performed in India during residency training compared with phacoemulsification, and are associated with lower complications rates (1.75% versus 8.2%) among novice surgeons.
Dr. Haripriya and colleagues conducted a prospective cohort study in which they sought to predict the average number of surgeries required for a resident to gain competency in MSICS using ICO-OSCAR.
All residents who started residency training at the Aravind Eye Hospital were included. The first 15 procedures and every tenth case thereafter were assessed using ICO-OSCAR, Dr. Vedachalam explained.
The ICO-OSCAR scoring tool contains 20 objectives, and scores each surgical step. The total score is then evaluated.
In this study, all surgical complications were documented during the step at which it occurred. A form was completed regarding various factors that may have affected the surgical outcome to determine their effect on the learning curve. The investigators compared the preoperative and postoperative visual acuities for significant differences, Dr. Vedachalam explained.
Twenty residents (mean age, 27.8 years) were included in the study, and two were excluded for excessive absences. Of the 18 remaining (11 women, 7 men), 15 had previous surgical experience with other surgeries.
A total of 2,021 surgeries were performed between September 2016 and May 2018. Surgical complications developed in 62 (3.06%) procedures, with posterior chamber opacification and zonulysis the most common complications.
“This complication rate is much lower than in other studies,” Dr. Vedachalam pointed out.
Twenty-eight (1.38%) patients underwent second surgeries. The mean best-corrected visual acuity at follow-up was 20/20.