title: Resident and fellow participation in strabismus surgery: effect of level of training and number of assistants on operative time and cost.
abstract: OBJECTIVE
  To investigate the effect of the level of training and number of assistants on operative time for uncomplicated, 2-muscle, horizontal strabismus surgery at an academic institution.
  
  
  METHODS
  Comparative case series.
  
  
  METHODS
  A total of 993 children and adults between the ages of 6 months and 75 years.
  
  
  METHODS
  Retrospective chart review of strabismus surgeries performed between July 1, 2008, and December 31, 2012, by any of 3 attending surgeons assisted by a resident in the postgraduate year 3 (PGY3), fellow in the postgraduate year 5 (PGY5), or both.
  
  
  METHODS
  Operative time (minutes) and associated operative cost (dollars).
  
  
  RESULTS
  There were 373 cases with 1 assistant and 44 cases with 2 assistants. Of all cases with 1 assistant, there were 200 cases with a PGY3 assistant an average operative time of 62.5 minutes (standard deviation [SD], 15.1) and 173 cases with a PGY5 assistant an average operative time of 59.0 minutes (SD, 14.7); the difference of 3.5 minutes was statistically significant (P = 0.02). The average operative time for all cases with 2 assistants (both PGY3 and PGY5) was 10.6 minutes longer than all cases with 1 assistant (P = 0.0002). No statistically significant variation in operative times was demonstrated when comparing cases with a PGY3 (P = 0.29) and PGY5 (P = 0.44) assistant in their respective first and last halves of the academic year, but operative times within individual quarters of the academic year were significant for PGY3 (P = 0.03) but not for PGY5 (P = 0.24) assistant cases. Operative times were significantly different for individual PGY3 (P = 0.03) but not PGY5 (P = 0.22) assistant cases. Cost per PGY3 assistant per year for additional operative time is $3141.95.
  
  
  CONCLUSIONS
  Operative time in strabismus surgery increased with PGY3 participation and further increased with both assistants over either assistant alone. Operative times earlier in the year did not vary from those later in the year for PGY3 or PGY5 assistants. The difference in quarterly and individual PGY3 but not PGY5 assistant operative times suggests that efficiency in strabismus surgery varies by assistants with less experience or interest.
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Iowa, Carver College of Medicine, Iowa City, Iowa.
authors.forename: Timothy W
authors.initials: TW
authors.lastname: Winter
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Iowa, Carver College of Medicine, Iowa City, Iowa.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Olson
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Iowa, Carver College of Medicine, Iowa City, Iowa.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Larson
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Iowa, Carver College of Medicine, Iowa City, Iowa.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Oetting
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Iowa, Carver College of Medicine, Iowa City, Iowa. Electronic address: susannah-longmuir@uiowa.edu.
authors.forename: Susannah Q
authors.initials: SQ
authors.lastname: Longmuir
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence / Q000191:economics*; D004503:Education, Medical, Graduate / Q000191:economics*; D006801:Humans; D007223:Infant; D007396:Internship and Residency; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000601:surgery; D009873:Operating Rooms / Q000191:economics; D061646:Operative Time; D013508:Ophthalmologic Surgical Procedures / Q000191:economics*; D009885:Ophthalmology / Q000193:education*; D012189:Retrospective Studies; D013285:Strabismus / Q000191:economics* / Q000601:surgery*; D055815:Young Adult