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Andrews HW, Lin GT, Lindsey JL, Ji X, Chen Q, Chomsky AS. Resident operative time as an independent predictor of early post-operative cataract surgery outcomes and supervising attending surgeon impact: a retrospective case series. BMC Ophthalmol 2024; 24:18. [PMID: 38200502 PMCID: PMC10777645 DOI: 10.1186/s12886-023-03278-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND The authors sought to determine if resident operative time in cataract extraction and intraocular lens insertion (CE/IOL) affects early visual outcomes and post-operative recovery. They further sought to investigate if attending surgeons can reduce resident operative time. METHODS This retrospective, chart-review, case series at single Veterans Affairs Hospital (VA Tennessee Valley Healthcare System) studied resident cataract surgeries between March 1, 2018 and March 31, 2020. Following power analysis, 420 eyes of 400 patients from all resident cataract surgeries were included. Eyes with attending as primary surgeon, laser-assisted cataract surgery, or concurrent secondary procedures were excluded. Linear mixed effect models were used to study the association between operative time and visual outcomes while adjusting for covariates including cumulative dissipated energy, preoperative factors, and intraoperative complications. RESULTS Longer operative time was statistically associated with worse post-operative-day 1 (POD1) pinhole visual acuity (PH-VA) adjusting for cumulative dissipated energy and other operative factors (p = 0.049). Although resident physicians were the primary surgeons, the operative times were different between the ten supervising attending surgeons in the study (p < 0.001). CONCLUSION The results suggest that increased resident operative time is a significant, independent risk factor for decreased POD1 PH-VA. Increased resident operative time is not associated with worsened long term visual outcomes. Attending surgeons may be able to reduce resident operative time, which is associated with improved early visual outcomes.
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Affiliation(s)
- Hans W Andrews
- Vanderbilt Eye Institute, 2311 Pierce Ave, Nashville, TN, 37232, USA.
- VA Tennessee Valley Healthcare System, 1310 24th Ave S, Nashville, TN, 37212, USA.
| | - George T Lin
- Vanderbilt Eye Institute, 2311 Pierce Ave, Nashville, TN, 37232, USA
- Vanderbilt University School of Medicine, 2209 Garland Ave, Nashville, TN, 37232, USA
| | - Jennifer L Lindsey
- Vanderbilt Eye Institute, 2311 Pierce Ave, Nashville, TN, 37232, USA
- VA Tennessee Valley Healthcare System, 1310 24th Ave S, Nashville, TN, 37212, USA
| | - Xiangyu Ji
- Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End, Nashville, TN, 37232, USA
| | - Qingxia Chen
- Vanderbilt Eye Institute, 2311 Pierce Ave, Nashville, TN, 37232, USA
- Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End, Nashville, TN, 37232, USA
| | - Amy S Chomsky
- Vanderbilt Eye Institute, 2311 Pierce Ave, Nashville, TN, 37232, USA
- VA Tennessee Valley Healthcare System, 1310 24th Ave S, Nashville, TN, 37212, USA
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Payal AR, Sola-Del Valle D, Gonzalez-Gonzalez LA, Cakiner-Egilmez T, Chomsky AS, Vollman DE, Baze EF, Lawrence M, Daly MK. American Society of Anesthesiologists classification in cataract surgery: Results from the Ophthalmic Surgery Outcomes Data Project. J Cataract Refract Surg 2018; 42:972-82. [PMID: 27492094 DOI: 10.1016/j.jcrs.2016.04.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 04/13/2016] [Accepted: 04/14/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To explore the association of American Society of Anesthesiologists (ASA) classification with cataract surgery outcomes. SETTING Five Veterans Affairs Medical Centers, United States. DESIGN Retrospective observational cohort study. METHODS The study analyzed the outcomes of cataract surgery cases. Corrected distance visual acuity (CDVA), unanticipated events, and vision-related quality of life (VRQL) were assessed using the National Eye Institute Visual Function Questionnaire (NEI-VFQ), comparing ASA classes I through IV. For some analyses, ASA classes I and II were designated as Group A and ASA classes III and IV were designated Group B. RESULTS Of the 4923 cases, 875 (17.8%) were in Group A, 4032 (81.9%) were in Group B, and 16 (0.3%) had missing data. The mean CDVA and mean composite NEI-VFQ score improved after cataract surgery in both groups (P < .0001); however, Group A had a better mean postoperative CDVA and postoperative VFQ composite scores than Group B (P < .0001, both outcomes). A higher ASA class was associated with an increased risk for 2 unanticipated events; that is, clinically significant macular edema (CSME) (Group A: 4 [0.47%] versus Group B: 50 [1.28%]; adjusted odds ratio [OR], 3.02; 95% confidence interval [CI], 1.02-13.05; P = 0.04) and readmission to the hospital within 30 days (2 [0.23%] versus 56 [1.41%]; OR, 8.26; 95% CI, 1.71-148.62; P = .004) CONCLUSIONS: Among United States veterans, the ASA classification could be an important predictor of VRQL and visual outcomes. In this cohort, it was associated with an increased risk for 2 serious unanticipated events-CSME and readmission to the hospital-both costly, unwanted outcomes. FINANCIAL DISCLOSURE Dr. Vollman is a consultant to Forsight Vision5. None of the authors has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Abhishek R Payal
- From the Ophthalmology Department (Payal, Sola-Del Valle, Gonzalez-Gonzalez, Cakiner-Egilmez, Daly), Veterans Affairs Boston Healthcare System, Jamaica Plain, Department of Ophthalmology (Daly), Boston University School of Medicine, and Department of Ophthalmology (Sola-Del Valle), Harvard Medical School (Payal, Daly), Boston, Massachusetts; Veteran Affairs Tennessee Valley Healthcare System Center (Chomsky) and Vanderbilt Eye Institute (Chomsky), Vanderbilt University Medical, Nashville, Tennessee; the Ophthalmology Department (Vollman), St. Louis Veteran Affairs Medical Center, and Department of Ophthalmology and Visual Sciences (Vollman), Washington University School of Medicine, St. Louis, Missouri; Michael E. DeBakey Veteran Affairs Medical Center (Baze) and Cullen Eye Institute (Baze), Baylor College of Medicine, Houston, Texas; and the Department of Defense/Veterans Affairs Vision Center of Excellence (Lawrence), Bethesda, Maryland, USA
| | - David Sola-Del Valle
- From the Ophthalmology Department (Payal, Sola-Del Valle, Gonzalez-Gonzalez, Cakiner-Egilmez, Daly), Veterans Affairs Boston Healthcare System, Jamaica Plain, Department of Ophthalmology (Daly), Boston University School of Medicine, and Department of Ophthalmology (Sola-Del Valle), Harvard Medical School (Payal, Daly), Boston, Massachusetts; Veteran Affairs Tennessee Valley Healthcare System Center (Chomsky) and Vanderbilt Eye Institute (Chomsky), Vanderbilt University Medical, Nashville, Tennessee; the Ophthalmology Department (Vollman), St. Louis Veteran Affairs Medical Center, and Department of Ophthalmology and Visual Sciences (Vollman), Washington University School of Medicine, St. Louis, Missouri; Michael E. DeBakey Veteran Affairs Medical Center (Baze) and Cullen Eye Institute (Baze), Baylor College of Medicine, Houston, Texas; and the Department of Defense/Veterans Affairs Vision Center of Excellence (Lawrence), Bethesda, Maryland, USA
| | - Luis A Gonzalez-Gonzalez
- From the Ophthalmology Department (Payal, Sola-Del Valle, Gonzalez-Gonzalez, Cakiner-Egilmez, Daly), Veterans Affairs Boston Healthcare System, Jamaica Plain, Department of Ophthalmology (Daly), Boston University School of Medicine, and Department of Ophthalmology (Sola-Del Valle), Harvard Medical School (Payal, Daly), Boston, Massachusetts; Veteran Affairs Tennessee Valley Healthcare System Center (Chomsky) and Vanderbilt Eye Institute (Chomsky), Vanderbilt University Medical, Nashville, Tennessee; the Ophthalmology Department (Vollman), St. Louis Veteran Affairs Medical Center, and Department of Ophthalmology and Visual Sciences (Vollman), Washington University School of Medicine, St. Louis, Missouri; Michael E. DeBakey Veteran Affairs Medical Center (Baze) and Cullen Eye Institute (Baze), Baylor College of Medicine, Houston, Texas; and the Department of Defense/Veterans Affairs Vision Center of Excellence (Lawrence), Bethesda, Maryland, USA
| | - Tulay Cakiner-Egilmez
- From the Ophthalmology Department (Payal, Sola-Del Valle, Gonzalez-Gonzalez, Cakiner-Egilmez, Daly), Veterans Affairs Boston Healthcare System, Jamaica Plain, Department of Ophthalmology (Daly), Boston University School of Medicine, and Department of Ophthalmology (Sola-Del Valle), Harvard Medical School (Payal, Daly), Boston, Massachusetts; Veteran Affairs Tennessee Valley Healthcare System Center (Chomsky) and Vanderbilt Eye Institute (Chomsky), Vanderbilt University Medical, Nashville, Tennessee; the Ophthalmology Department (Vollman), St. Louis Veteran Affairs Medical Center, and Department of Ophthalmology and Visual Sciences (Vollman), Washington University School of Medicine, St. Louis, Missouri; Michael E. DeBakey Veteran Affairs Medical Center (Baze) and Cullen Eye Institute (Baze), Baylor College of Medicine, Houston, Texas; and the Department of Defense/Veterans Affairs Vision Center of Excellence (Lawrence), Bethesda, Maryland, USA
| | - Amy S Chomsky
- From the Ophthalmology Department (Payal, Sola-Del Valle, Gonzalez-Gonzalez, Cakiner-Egilmez, Daly), Veterans Affairs Boston Healthcare System, Jamaica Plain, Department of Ophthalmology (Daly), Boston University School of Medicine, and Department of Ophthalmology (Sola-Del Valle), Harvard Medical School (Payal, Daly), Boston, Massachusetts; Veteran Affairs Tennessee Valley Healthcare System Center (Chomsky) and Vanderbilt Eye Institute (Chomsky), Vanderbilt University Medical, Nashville, Tennessee; the Ophthalmology Department (Vollman), St. Louis Veteran Affairs Medical Center, and Department of Ophthalmology and Visual Sciences (Vollman), Washington University School of Medicine, St. Louis, Missouri; Michael E. DeBakey Veteran Affairs Medical Center (Baze) and Cullen Eye Institute (Baze), Baylor College of Medicine, Houston, Texas; and the Department of Defense/Veterans Affairs Vision Center of Excellence (Lawrence), Bethesda, Maryland, USA
| | - David E Vollman
- From the Ophthalmology Department (Payal, Sola-Del Valle, Gonzalez-Gonzalez, Cakiner-Egilmez, Daly), Veterans Affairs Boston Healthcare System, Jamaica Plain, Department of Ophthalmology (Daly), Boston University School of Medicine, and Department of Ophthalmology (Sola-Del Valle), Harvard Medical School (Payal, Daly), Boston, Massachusetts; Veteran Affairs Tennessee Valley Healthcare System Center (Chomsky) and Vanderbilt Eye Institute (Chomsky), Vanderbilt University Medical, Nashville, Tennessee; the Ophthalmology Department (Vollman), St. Louis Veteran Affairs Medical Center, and Department of Ophthalmology and Visual Sciences (Vollman), Washington University School of Medicine, St. Louis, Missouri; Michael E. DeBakey Veteran Affairs Medical Center (Baze) and Cullen Eye Institute (Baze), Baylor College of Medicine, Houston, Texas; and the Department of Defense/Veterans Affairs Vision Center of Excellence (Lawrence), Bethesda, Maryland, USA
| | - Elizabeth F Baze
- From the Ophthalmology Department (Payal, Sola-Del Valle, Gonzalez-Gonzalez, Cakiner-Egilmez, Daly), Veterans Affairs Boston Healthcare System, Jamaica Plain, Department of Ophthalmology (Daly), Boston University School of Medicine, and Department of Ophthalmology (Sola-Del Valle), Harvard Medical School (Payal, Daly), Boston, Massachusetts; Veteran Affairs Tennessee Valley Healthcare System Center (Chomsky) and Vanderbilt Eye Institute (Chomsky), Vanderbilt University Medical, Nashville, Tennessee; the Ophthalmology Department (Vollman), St. Louis Veteran Affairs Medical Center, and Department of Ophthalmology and Visual Sciences (Vollman), Washington University School of Medicine, St. Louis, Missouri; Michael E. DeBakey Veteran Affairs Medical Center (Baze) and Cullen Eye Institute (Baze), Baylor College of Medicine, Houston, Texas; and the Department of Defense/Veterans Affairs Vision Center of Excellence (Lawrence), Bethesda, Maryland, USA
| | - Mary Lawrence
- From the Ophthalmology Department (Payal, Sola-Del Valle, Gonzalez-Gonzalez, Cakiner-Egilmez, Daly), Veterans Affairs Boston Healthcare System, Jamaica Plain, Department of Ophthalmology (Daly), Boston University School of Medicine, and Department of Ophthalmology (Sola-Del Valle), Harvard Medical School (Payal, Daly), Boston, Massachusetts; Veteran Affairs Tennessee Valley Healthcare System Center (Chomsky) and Vanderbilt Eye Institute (Chomsky), Vanderbilt University Medical, Nashville, Tennessee; the Ophthalmology Department (Vollman), St. Louis Veteran Affairs Medical Center, and Department of Ophthalmology and Visual Sciences (Vollman), Washington University School of Medicine, St. Louis, Missouri; Michael E. DeBakey Veteran Affairs Medical Center (Baze) and Cullen Eye Institute (Baze), Baylor College of Medicine, Houston, Texas; and the Department of Defense/Veterans Affairs Vision Center of Excellence (Lawrence), Bethesda, Maryland, USA
| | - Mary K Daly
- From the Ophthalmology Department (Payal, Sola-Del Valle, Gonzalez-Gonzalez, Cakiner-Egilmez, Daly), Veterans Affairs Boston Healthcare System, Jamaica Plain, Department of Ophthalmology (Daly), Boston University School of Medicine, and Department of Ophthalmology (Sola-Del Valle), Harvard Medical School (Payal, Daly), Boston, Massachusetts; Veteran Affairs Tennessee Valley Healthcare System Center (Chomsky) and Vanderbilt Eye Institute (Chomsky), Vanderbilt University Medical, Nashville, Tennessee; the Ophthalmology Department (Vollman), St. Louis Veteran Affairs Medical Center, and Department of Ophthalmology and Visual Sciences (Vollman), Washington University School of Medicine, St. Louis, Missouri; Michael E. DeBakey Veteran Affairs Medical Center (Baze) and Cullen Eye Institute (Baze), Baylor College of Medicine, Houston, Texas; and the Department of Defense/Veterans Affairs Vision Center of Excellence (Lawrence), Bethesda, Maryland, USA.
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Rapoport Y, Wayman LL, Chomsky AS. The effect of post-traumatic-stress-disorder on intra-operative analgesia in a veteran population during cataract procedures carried out using retrobulbar or topical anesthesia: a retrospective study. BMC Ophthalmol 2017; 17:85. [PMID: 28592279 PMCID: PMC5463357 DOI: 10.1186/s12886-017-0479-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 05/28/2017] [Indexed: 11/16/2022] Open
Abstract
Background A growing proportion of veterans treated at the Veterans Health Administration (VA) have a history of post-traumatic-stress-disorder (PTSD), and there exists a higher rate of PTSD amongst veterans than the general population. The purpose of this study is to determine the correlation between PTSD and intra-operative analgesia, intra-operative time, and anesthesia type for cataract surgery in a veteran population. Secondary objectives are to determine if patient age, and first or second eye surgery affect intra-operative pain control or are correlated with type of anesthesia modality. Methods A retrospective study of 330 cataract surgeries performed by resident physicians between January and September 2012 at the Veterans Affairs Medical Center Tennessee Valley Healthcare System, Nashville and Murfreesboro Campuses was completed. Three hundred and thirty veteran patients were selected if their cataract surgery was performed between January and September 2012. Combined cases were excluded. The primary outcome evaluated was intra-operative analgesia. Secondary outcomes included history of post-traumatic-stress-disorder, anesthesia type, first or second eye, pain control, intra-operative heart rate and blood pressure, age, and case complexity. Data was analyzed using an unpaired two-sample Welch’s t-test assuming unequal variance and Z test of comparison of proportions. Results Patients with post-traumatic-stress-disorder reported higher pain scores, had longer operative times, and were more likely to have received a retrobulbar block. Operative time was not associated with an increased pain score, irrespective of anesthesia type, when controlled for PTSD. Complex cases had longer operative times, more sedation, and higher pain scores. P < 0.05 was used consistently. Conclusions Post-traumatic stress disorder and anxiety are more prevalent in the veteran population. Our data suggests that a history of post-traumatic-stress-disorder was correlated with higher pain scores, longer operative times, and with having received a retrobulbar block. Patients without a history of PTSD were more likely to have received topical anesthesia with or without sedation. The veteran population requires more sedation to allay anxiety and perceptions of discomfort, which may account for longer surgical times. The veteran population is a special population and it is important to investigate how PTSD in the veteran population affects intra-operative analgesia.
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Affiliation(s)
- Yuna Rapoport
- VA Tennessee Valley Healthcare System, Nashville, Tennessee, USA. .,Vanderbilt Eye Institute, Nashville, Tennessee, USA. .,Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, 02114, USA.
| | - Laura L Wayman
- VA Tennessee Valley Healthcare System, Nashville, Tennessee, USA.,Vanderbilt Eye Institute, Nashville, Tennessee, USA
| | - Amy S Chomsky
- VA Tennessee Valley Healthcare System, Nashville, Tennessee, USA.,Vanderbilt Eye Institute, Nashville, Tennessee, USA
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