The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Ophthalmology. 2011 May;118(5):954-8. doi: 10.1016/j.ophtha.2010.08.047.
To determine whether year of residency is associated with intraoperative phacoemulsification complication rates.
Retrospective cohort study.
One attending physician supervised 691 resident-performed phacoemulsification procedures on 492 patients. Second- and third-year residents performed 228 and 463 cases, respectively.
All resident-performed phacoemulsification procedures performed between October 2003 and June 2008 and supervised by one attending surgeon (SR) were considered for this study. Data were collected on the residency year of the physician performing the surgery, preoperative risk indicators, and intraoperative complications, including anterior and posterior capsular tears with or without vitreous loss, zonular dialysis or dehiscence, burns, nuclear fragment loss, and Descemet's membrane tear. Cases were classified as difficult if they had 1 or more preoperative risk indicators including: pseudoexfoliation; proliferative diabetic retinopathy; prior vitrectomy; a 4+ dense, white, or brunescent cataract; current Flomax (Boehringer-Ingelheim, Ingelheim, Germany) use, pre-existing zonular dialysis; and intraoperative use of Trypan blue, iris hooks, or pupil dilator. Intraoperative complications are presented as rate per 100 surgeries (95% confidence intervals [CIs]).
Intraoperative complication rates and case difficulty.
Fifty-three patients experienced at least 1 complication, with 25 cases experiencing multiple complications. Intraoperative complication rates were similar among second- and third-year resident groups (7.9% vs. 7.6%; P = 0.88). Similarly, vitreous loss rates among second- and third-year residents were comparable (4.8% vs. 3.0%; P = 0.27). Risk indicators were more common among third-year cases (24.6% vs. 15.8%; P = 0.008). Having 1 or more risk indicators increased the odds of an intraoperative complication (odds ratio [OR], 3.09; 95% CI, 1.73-5.49). After controlling for risk indicators, second-year resident surgeries still had a similar risk of intraoperative complications as third-year resident surgeries (OR, 1.15; 95% CI, 0.6-2.19).
The year of residency did not significantly influence intraoperative complication rates, even after controlling for differences in case difficulty.
确定住院医师年限是否与术中超声乳化并发症发生率有关。
回顾性队列研究。
一位主治医生监督了 691 名住院医师对 492 名患者进行的超声乳化手术。第二年和第三年的住院医师分别进行了 228 例和 463 例手术。
考虑了 2003 年 10 月至 2008 年 6 月间由一位主治医生（SR）监督的所有住院医师进行的超声乳化手术。数据收集了手术医生的住院医师年限、术前风险指标和术中并发症，包括有或无玻璃体损失的前囊和后囊撕裂、悬韧带裂离或断裂、灼伤、核碎片损失和 Descemet 膜撕裂。如果病例有 1 个或多个术前风险指标，包括：假性剥脱综合征；增殖性糖尿病视网膜病变；既往玻璃体切除术；4+致密、白色或棕褐色白内障；当前使用 Flomax（Boehringer-Ingelheim，Ingelheim，德国）；预先存在的悬韧带裂离；以及术中使用 Trypan 蓝、虹膜钩或瞳孔扩张器，则将其归类为困难病例。术中并发症以每 100 例手术的发生率（95%置信区间[CI]）表示。
术中并发症发生率和病例难度。
53 名患者至少经历了 1 次并发症，25 名患者经历了多种并发症。第二年和第三年住院医师组的术中并发症发生率相似（7.9%比 7.6%；P = 0.88）。同样，第二年和第三年住院医师的玻璃体损失率也相似（4.8%比 3.0%；P = 0.27）。第三年病例的风险指标更为常见（24.6%比 15.8%；P = 0.008）。有 1 个或多个风险指标会增加术中并发症的几率（比值比[OR]，3.09；95%CI，1.73-5.49）。在控制风险指标后，第二年住院医师手术的术中并发症风险与第三年住院医师手术相似（OR，1.15；95%CI，0.6-2.19）。
即使在控制病例难度差异后，住院医师年限也未显著影响术中并发症发生率。
