title: Blepharoptosis repair outcomes from trainee versus experienced staff as the primary surgeon.
abstract: OBJECTIVE
  To compare outcomes of conjunctival Müllerectomy with or without tarsectomy versus external levator advancement for correction of upper blepharoptosis when performed by trainee versus staff surgeons.
  
  
  METHODS
  Retrospective, nonrandomized, interventional, consecutive case series.
  
  
  METHODS
  Charts of patients undergoing conjunctival Müllerectomy with or without tarsectomy and external levator advancement blepharoptosis repair from January 2006 through December 2009 were reviewed. Main outcome measures included age, gender, preoperative and postoperative use of artificial tears, preoperative and postoperative marginal reflex distance, surgical complications, surgeon (trainee or staff surgeon), and anesthesia time. The Student t test was used for statistical analysis.
  
  
  RESULTS
  A total of 170 patients underwent 248 surgeries (154 conjunctival Müllerectomies with or without tarsectomy and 94 external levator advancements). There were 108 female and 62 male patients. Mean patient age was 62 years (range, 3 to 94 years). Forty-one (24%) patients (26 conjunctival Müllerectomies with or without tarsectomy and 15 external levator advancements) underwent concurrent eyelid surgery, such as blepharoplasty. Trainees performed surgery on a total of 88 (35%) eyelids in 60 patients (35%). There was no significant difference in the percentage of cases undergoing concomitant surgery between trainee and staff surgeons (P = .18). The mean postoperative marginal reflex distance difference was 0.53 and 0.59 for trainee and staff surgeons, respectively. Mean overall anesthesia time was 26.8 minutes and 30.3 minutes for trainee and staff surgeons, respectively. Complications, including increase in dry eye or irritative symptoms and reoperation, occurred in 8 (13%) of 60 patients undergoing surgery by a trainee surgeon and in 22 (20%) of 110 patients undergoing surgery by staff surgeon. There was no significant difference in eyelid symmetry (P = .55), mean anesthesia time (P = .14), complication rate (P = .26), or reoperation rate (P = .17) when surgery was performed by a trainee versus a staff surgeon.
  
  
  CONCLUSIONS
  There is no significant difference in mean postoperative marginal reflex distance, mean anesthesia time, complication rate, or reoperation rate between either conjunctival Müllerectomy with or without tarsectomy or external levator advancement blepharoptosis repair performed by trainee versus staff surgeons.
authors.affiliation: Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: Viraj J
authors.initials: VJ
authors.lastname: Mehta
authors.forename: Julian D
authors.initials: JD
authors.lastname: Perry
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019882:Blepharoplasty / Q000193:education*; D001763:Blepharoptosis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence / Q000592:standards*; D003228:Conjunctiva / Q000601:surgery; D005143:Eyelids / Q000601:surgery; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D008297:Male; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000601:surgery; D009885:Ophthalmology / Q000193:education*; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D013710:Tendons / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult