Risk Factors for Return to the Operating Room after Resident-Performed Cataract Surgery.
OBJECTIVE
Investigate risk factors for unplanned return to the operating room after resident-performed cataract surgery.


METHODS
Retrospective case-control study.


METHODS
Institutional.


METHODS
Study population: All patients with reoperation within 90 days of resident-performed phacoemulsification were matched to four control eyes which had surgery within 30 days of the reoperation at the same institution.


METHODS
Billing codes were used to identify all patients who underwent resident-performed intended phacoemulsification with intraocular lens placement from January 2005 to December 2010.


METHODS
Investigated risk factors for reoperation included cataract characteristics and preexisting ocular co-morbidities, including diabetic retinopathy, retinal detachment history, glaucoma, corneal pathology, and uveitis. Additional preoperative risk factors studied included resident training year, history of tamsulosin use, phacodonesis, pupillary dilation, presence of pseudoexfoliation, myopia, history of trauma, visual acuity, and monocular status. Intraoperative variables were the use of iris expansion devices, use of capsular stain, attending type, incision type, use of sutures, vitreous loss, anesthesia type, and phacoemulsification technique.


RESULTS
There were 67 returns to the operating room (i.e., cases) over five years that were assigned to 268 control eyes. In preoperative multivariate analysis, phacoemulsification done by a first- or second-year resident (OR 3.2, 95% CI: 1.7-6.0, p < 0.001) was associated with an increased risk of reoperation. In postoperative multivariate analysis, only the use of the divide-and-conquer technique (OR 4.0, 95% CI:1.7-9.2, p = 0.001) was associated with an increased risk of reoperation.


CONCLUSIONS
Phacoemulsification done by a junior resident or using the divide-and-conquer technique had the highest risk of reoperation.
a Department of Ophthalmology , University of California, San Francisco , San Francisco , CA , USA.
Shivali A
SA
Menda
a Department of Ophthalmology , University of California, San Francisco , San Francisco , CA , USA.
Todd H
TH
Driver
a Department of Ophthalmology , University of California, San Francisco , San Francisco , CA , USA.|b Department of Ophthalmology , San Francisco General Hospital , San Francisco , CA , USA.
Alexandra E
AE
Neiman
c Francis I. Proctor Foundation , University of California San Francisco , San Francisco , CA , USA.
Seth
S
Blumberg
a Department of Ophthalmology , University of California, San Francisco , San Francisco , CA , USA.|c Francis I. Proctor Foundation , University of California San Francisco , San Francisco , CA , USA.|d Department of Ophthalmology , San Francisco VA Medical Center , San Francisco , CA , USA.
Ayman
A
Naseri
a Department of Ophthalmology , University of California, San Francisco , San Francisco , CA , USA.|b Department of Ophthalmology , San Francisco General Hospital , San Francisco , CA , USA.
Jay M
JM
Stewart
D000368:Aged; D002387:Cataract Extraction / Q000193:education*; D005260:Female; D006801:Humans; D015994:Incidence; D007396:Internship and Residency / Q000592:standards; D008297:Male; D009873:Operating Rooms / Q000706:statistics & numerical data*; D061646:Operative Time; D009885:Ophthalmology / Q000193:education*; D063868:Patient Outcome Assessment; D011183:Postoperative Complications / Q000453:epidemiology*; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014792:Visual Acuity
Cataract surgery; phacoemulsification; reoperation; residency training; risk factors