title: Intraoperative phacoemulsification complication rates of second- and third-year ophthalmology residents a 5-year comparison.
abstract: OBJECTIVE
  To determine whether year of residency is associated with intraoperative phacoemulsification complication rates.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  One attending physician supervised 691 resident-performed phacoemulsification procedures on 492 patients. Second- and third-year residents performed 228 and 463 cases, respectively.
  
  
  METHODS
  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]).
  
  
  METHODS
  Intraoperative complication rates and case difficulty.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  The year of residency did not significantly influence intraoperative complication rates, even after controlling for differences in case difficulty.
authors.affiliation: The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. alonzo.woodfield@gmail.com
authors.forename: Alonzo S
authors.initials: AS
authors.lastname: Woodfield
authors.forename: Emily W
authors.initials: EW
authors.lastname: Gower
authors.forename: Sandra D
authors.initials: SD
authors.lastname: Cassard
authors.forename: Saraswathy
authors.initials: S
authors.lastname: Ramanthan
mesh_terms: D000368:Aged; D002983:Clinical Competence / Q000592:standards*; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data*; D007431:Intraoperative Complications; D008297:Male; D016017:Odds Ratio; D009885:Ophthalmology / Q000193:education*; D018918:Phacoemulsification / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors