Complicated cataract surgery performed by trainee ophthalmic surgeons: will preoperative risk scoring help?

Session Details

Session Title: Training & Surgical Practice

Session Date/Time: Tuesday 25/09/2018 | 16:00-18:00

Paper Time: 16:00

Venue: Room A2

First Author: : A.Shinton UK

Co Author(s): :    A. Jonas   S. Abbas   P. Lo   S. Balendra   H. Bobat   M. Ramchandani     

Abstract Details

Purpose:

‘The Way Forward’ project by The Royal College of Ophthalmologists (London, UK) has recommended preoperative risk scoring of cataract cases. Cataract patients are graded according to several surgical risk factors such as age, ocular co-morbidity, and axial length. Such systems aim to improve scheduling of training lists, and to reduce the frequency of intraoperative complications for trainee cataract surgeons. In this study, we retrospectively calculate the risk scores of patients who underwent complicated cataract surgery performed by trainee ophthalmic surgeons. We assess how their scores compare to the risk scores of typical cataract cases on current training lists.

Setting:

The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, UK

Methods:

All intraoperative cataract surgery complications encountered by six trainee ophthalmic surgeons at a single UK hospital between August 2016 and February 2018 were identified using electronic surgical logbooks. The trainees ranged from their second to their fifth year of ophthalmic training. Surgical risk scores were calculated for all cases with intraoperative complications, using a published grading system. Pre- and postoperative visual acuity was recorded. Surgical risk scores were also calculated for all cataract cases available to trainees on 10 theatre lists at the same unit.

Results:

Six trainee surgeons performed 734 cataract operations during the study period, mostly under consultant supervision. Prior surgical experience ranged from 1 to 429 completed cases (median 52). 32 intraoperative complications occurred, including posterior capsule rupture with or without vitreous loss (n=17; 2.32%), zonular dialysis (n=6; 0.82%), dropped nucleus (n=4; 0.54%), and suprachoroidal haemorrhage (n=2; 0.27%). Median postoperative visual acuity after complicated surgery was 6/7.5 (range 6/4–6/36). Complicated cases had a median preoperative risk score of 1.5 (range 0.0–6.0). Uncomplicated trainee cases on ten consecutive theatre lists had a median preoperative risk score of 1.5 (range 0.0–5.5).

Conclusions:

We found no difference between the preoperative risk scores of complicated versus uncomplicated cataract cases performed by trainee ophthalmic surgeons. Complications occur not only in ‘high risk’ but also in ‘low risk’ eyes, making predicting trainee complications difficult. We note good postoperative visual acuity was achieved in almost all complicated cases. Over half (54%) of cases on typical training lists had a risk score ≥3.0, which would have precluded surgery by a trainee. We conclude that the parameters of risk scoring tools must be carefully considered to avoid placing further restrictions on the experience available to trainee cataract surgeons.

Financial Disclosure:

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