Outcomes of Resident-versus attending-performed Tube Shunt Surgeries in a United States Residency Program
Loka Thangamathesvaran, Elliot Crane, Kunjal Modi, Albert S Khouri
Cohort study, Educational training, Glaucoma, Resident versus attending, Tube shunt surgery
Citation Information :
Thangamathesvaran L, Crane E, Modi K, Khouri AS. Outcomes of Resident-versus attending-performed Tube Shunt Surgeries in a United States Residency Program. J Curr Glaucoma Pract 2018; 12 (2):53-58.
Introduction: Glaucoma is a chronic optic neuropathy with increasing global prevalence, necessitating trainees in ophthalmology to be well-trained in the surgical modalities used to manage glaucoma. It is also important to not compromise patient safety and treatment efficacy for training and education. The purpose of our analysis is to compare postoperative outcomes of resident versus (vs.) attending performed tube shunt surgeries (TS).
Materials and methods: A retrospective, chart review was performed of patients who had undergone TS between 2009 and 2015 at Rutgers University in Newark, New Jersey, USA. Inclusion criteria was patients with a confirmed diagnosis of glaucoma, who underwent either an Ahmed or Baerveldt TS, and had at least two evaluation visits before the surgery to establish baseline characteristics. Exclusion criteria were patients with follow up for less than 1 year. The main outcome measure was the surgical success at 1 year follow up after TS. Surgical success was defined according to recommendations from the Glaucoma Surgical Trials guidelines published by the World Glaucoma Association (WGA):
20% reduction in IOP and absolute IOP ≤ 21 mm Hg (criteria 1)
30% reduction in IOP and absolute IOP ≤ 18 mm Hg (criteria 2)
Results: A total of 120 cases: 60 attending and 60 resident cases that met all the inclusion criteria and none of the exclusion criteria were included. The mean intraocular pressure (IOP) one year post surgery were 15.06 ± 3.55 and 15.21 ± 5.17 mm Hg for attendings and residents respectively (p = 0.422). At the 1 year time point, 87% of resident cases and 95% of attending cases met the qualifications of criteria 1 for success. Kaplan Meier analysis was performed and did not show a significant difference in the outcome (p = 0.325). At the 1 year time point, 80% of attending and resident cases met the qualifications of criteria 2 for success. Kaplan–Meier analysis was performed and did not show a significant difference in the outcome (p = 0.401). There were no differences in complication and failure rates between resident and attending performed cases. Resident-performed cases had a longer intraoperative time in comparison to attending performed cases (p = 0.02).
Conclusion: Resident-performed surgeries are as effective as attending performed surgeries. Resident-performed TS does not compromise safety and better prepares future physicians to deliver optimal care.
Clinical Significance: Attendings may consider incorporating more resident performed, attending supervised TS procedures into their clinical practice as surgical training to manage common ophthalmological conditions like glaucoma is essential to residency training.
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