Moussa Omar, Frank Tahvi, Valenzuela Ives A, Aliancy Joah, Gong Dan, De Rojas Joaquin O, Dagi Glass Lora R, Winn Bryan J, Cioffi George A, Chen Royce W S
Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA.
Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
Clin Ophthalmol. 2022 Jul 1;16:2137-2144. doi: 10.2147/OPTH.S368633. eCollection 2022.
To evaluate efficacy of a novel risk stratification system in minimizing resident surgical complications and to evaluate whether the system could be used to safely introduce cataract surgery to earlier levels of training.
This is a retrospective cross-sectional study on 530 non-consecutive cataract cases performed by residents at Columbia University. Risk scores, preoperative best corrected visual acuity (BCVA), intraoperative complications, postoperative day 1 (POD1), and month 1 (POM1) exam findings were tabulated. The relationship between risk scores and POD1 and POM1 BCVA was modeled using linear regression. The relationship between risk scores and complication rates was modeled using logistic regression. Logistic regression was used to model the rates of complications across different levels of training. Rates of complications were compared between diabetic versus non-diabetic patients using t-tests.
Risk scores did not have significant association with intraoperative complications. Risk scores were predictive of corneal edema (OR = 1.36, p = 0.0032) and having any POM1 complication (OR = 1.20, p = 0.034). Risk scores were predictive of POD1 ( = 0.13, p < 0.0001) and POM1 ( = 0.057, p = 0.00048) visual acuity. There was no significant association between level of training and rates of intraoperative (p = 0.9) or postoperative complications (p = 0.06). Rates of intraoperative complication trended higher among diabetic patients but was not statistically significant (p = 0.2).
Higher risk scores were predictive of prolonged corneal edema but not risk of intraoperative complications. Our risk stratification system allowed us to safely introduce earlier phacoemulsification surgery.
评估一种新型风险分层系统在将住院医师手术并发症降至最低方面的疗效，并评估该系统是否可用于安全地将白内障手术引入更早的培训阶段。
这是一项对哥伦比亚大学住院医师进行的530例非连续性白内障病例的回顾性横断面研究。将风险评分、术前最佳矫正视力（BCVA）、术中并发症、术后第1天（POD1）和第1个月（POM1）的检查结果制成表格。使用线性回归对风险评分与POD1和POM1时的BCVA之间的关系进行建模。使用逻辑回归对风险评分与并发症发生率之间的关系进行建模。使用逻辑回归对不同培训水平的并发症发生率进行建模。使用t检验比较糖尿病患者与非糖尿病患者的并发症发生率。
风险评分与术中并发症无显著关联。风险评分可预测角膜水肿（OR = 1.36，p = 0.0032）以及发生任何POM1并发症（OR = 1.20，p = 0.034）。风险评分可预测POD1（β = 0.13，p < 0.0001）和POM1（β = 0.057，p = 0.00048）时的视力。培训水平与术中（p = 0.9）或术后并发症发生率（p = 0.06）之间无显著关联。糖尿病患者术中并发症发生率有升高趋势，但无统计学意义（p = 0.2）。
较高的风险评分可预测角膜水肿持续时间延长，但不能预测术中并发症风险。我们的风险分层系统使我们能够安全地引入更早阶段的超声乳化手术。
