Risk factors for intraoperative complications in resident-performed phacoemulsification surgery.
OBJECTIVE
To determine the risk factors for intraoperative complications in resident-performed phacoemulsification surgery and the effect of complications on postoperative visual acuity.


METHODS
Retrospective case series.


METHODS
A total of 320 consecutive eyes of predominantly male (96.6%) and elderly patients (mean age +/-1 standard deviation = 73.1+/-10.0 years) undergoing phacoemulsification surgery by ophthalmology residents at a Veterans Administration Hospital between January 2006 and 2007. There were no exclusion criteria for type of cataract undergoing phacoemulsification surgery.


METHODS
Data were collected by review of patients' electronic medical records. Collected data included the patient demographics, ocular comorbidities, cataract features, resident, resident experience, attending, right or left eye, anesthesia type, wound type, phacoemulsification technique, preoperative and postoperative visual acuities, and presence of any intraoperative complication. Multivariate models were constructed to determine potential risk factors for intraoperative complications.


METHODS
Major intraoperative complication rate, risk factors for major intraoperative complications, and best-corrected postoperative visual acuity.


RESULTS
The major intraoperative complication rate was 4.7%, which included 3.1% of cases with vitreous loss. The strongest association with a major complication was the presence of a case identified as challenging preoperatively, which had an odds ratio of 6.0 (95% confidence interval [CI], 1.5-24.1, P=0.01). The challenging features most strongly associated with major complications were mature 4+ nuclear sclerotic cataracts and zonular pathology (antecedent trauma and pseudoexfoliation), which had odds ratios of 18.9 (95% CI, 3.1-117, P=0.002) and 26.2 (95% CI, 4.3-159, P=0.003), respectively. A major complication decreased the likelihood of achieving 20/40 or better visual acuity within 90 days of surgery (95% of uncomplicated eyes vs. 71% of complicated eyes; P=0.009).


CONCLUSIONS
Residents performing phacoemulsification surgery achieved a low overall rate of major complications. However, specific features of cataracts, such as mature nuclei and zonular pathology, carried increased intraoperative risk. Anticipating risk may help to decrease surgical complications further and to counsel patients appropriately.
Rutar
Tina
T
Department of Ophthalmology, University of California San Francisco, San Francisco, California.
Porco
Travis C
TC
Naseri
Ayman
A
D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence / Q000592:standards*; D004503:Education, Medical, Graduate; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data*; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D009885:Ophthalmology / Q000193:education*; D018918:Phacoemulsification; D012189:Retrospective Studies; D012307:Risk Factors; D014792:Visual Acuity / Q000502:physiology