Saifee Murtaza, Zhu Ivy, Lin Ying, Oldenburg Catherine E, Ramanathan Saras
From the Department of Ophthalmology (Saifee, Zhu, Ramanathan), F. I. Proctor Foundation (Lin, Oldenburg), University of California San Francisco, San Francisco, California, and Department of Ophthalmology and Visual Sciences (Zhu), Illinois Eye and Ear Infirmary, University of Illinois, Chicago, Illinois, USA. Corresponding author: Saras Ramanathan, MD, Department of Ophthalmology, University of California, San Francisco, 10 Koret Way, K304, San Francisco, CA 94143, USA. Email:
J Cataract Refract Surg. 2020 May;46(5):700-704. doi: 10.1097/j.jcrs.0000000000000145.
To examine the effect of teaching experience of supervising surgeons on resident cataract surgery intraoperative complication rates.
Zuckerberg San Francisco General Hospital, University of California San Francisco, USA.
Retrospective chart review.
Cataract surgeries performed by University of California San Francisco (UCSF) ophthalmology residents from 2010 to 2017 were reviewed. Only cases supervised by anterior segment attendings with more than 10 years of postresidency surgical experience were included. Cases were categorized as being supervised by either full-time UCSF teaching attendings or volunteer private practice attendings. Cases were graded as low risk (0 risk factors), intermediate risk (1 risk factor), or high risk (≥2 risk factors) based on 8 preoperative and intraoperative risk factors. Complication rates were compared between the 2 attending groups among varying risk grades.
Of 1377 cases, 101 developed complications. Among low-risk cases, full-time teaching attendings (25/619 [4.04%]) had a similar complication rate to volunteer attendings (17/387 [4.39%]) (odds ratio [OR] 0.92; P = .79). In intermediate-risk cases, full-time teaching attendings (28/195 [14.36%]) had slightly worse complication rates than volunteer attendings (10/88 [11.36%]) (OR 1.63; P = .45). High-risk cases had the highest complication rates, with the complication rates of full-time teaching attendings (16/72 [22.22%]) somewhat lower than those of volunteer attendings (5/16 [31.25%]) (OR 0.64; P = .48).
For low-risk resident-performed cataract surgeries, supervision by full-time faculty and volunteer attendings yielded similar complication rates; thus, residency programs might safely recruit volunteer attendings to supervise low-risk cataract surgeries to support resident training. The analysis of higher-risk cases was limited by a low surgical volume.
探讨指导外科医生的教学经验对住院医师白内障手术术中并发症发生率的影响。
美国加利福尼亚大学旧金山分校扎克伯格旧金山总医院。
回顾性病历审查。
回顾了2010年至2017年加利福尼亚大学旧金山分校（UCSF）眼科住院医师进行的白内障手术。仅纳入由具有超过10年住院后手术经验的眼前节主治医师指导的病例。病例分为由UCSF全职教学主治医师或志愿私人执业主治医师指导。根据8个术前和术中危险因素，病例被分为低风险（0个危险因素）、中度风险（1个危险因素）或高风险（≥2个危险因素）。比较了两个主治医师组在不同风险等级中的并发症发生率。
在1377例病例中，101例出现并发症。在低风险病例中，全职教学主治医师（25/619 [4.04%]）的并发症发生率与志愿主治医师（17/387 [4.39%]）相似（优势比[OR] 0.92；P = 0.79）。在中度风险病例中，全职教学主治医师（28/195 [14.36%]）的并发症发生率略高于志愿主治医师（10/88 [11.36%]）（OR 1.63；P = 0.45）。高风险病例的并发症发生率最高，全职教学主治医师（16/72 [22.22%]）的并发症发生率略低于志愿主治医师（5/16 [31.25%]）（OR 0.64；P = 0.48）。
对于低风险的住院医师白内障手术，全职教员和志愿主治医师的指导产生了相似的并发症发生率；因此，住院医师培训项目可以安全地招募志愿主治医师来指导低风险白内障手术，以支持住院医师培训。高风险病例的分析因手术量低而受到限制。
