Resident participation may increase surgery length, cost around beginning of academic year

This retrospective study investigated the impact of resident participation on the operative time and cost of cataract surgery. It found that resident participation was associated with significantly increased phacoemulsification operative times and costs during the first half of the academic year.

Subjects underwent phacoemulsification cataract surgery performed by an attending or resident surgeon of Penn State Hershey Eye Center from 2004 to 2007. Each third-year resident begins phacoemulsification training with a first full case in July of the academic year. The primary surgeon was an attending physician in 474 cases and a senior resident physician in 473 cases.

Phacoemulsification surgeries took an average of 12 minutes and 41 seconds longer per eye when performed by a senior resident compared with an attending surgeon (P = 0.027). Resident cases averaged 63 minutes in July, and decreased to an average of 27 minutes in June. The monthly mean operative case length for resident cases was significantly longer than the mean operative case length for attending cases in every month from July through December (P < 0.05), except for November, when the difference was borderline significant. From January through June, there was no difference.

The authors note that small portions of phacoemulsification surgery are taught to second-year residents during the months leading up to July of their third year. Case severity differential, whereby residents may have easier surgical cases compared with attending residents’ cases, would be expected to be greatest early in the academic year. They also note that some months had few surgeries, or large operative time variability, compared with other months. The number of surgeries performed by residents ranges between 29 and 52 cases per month, with the exception of July, during which there were only 16 resident cases. Therefore, the authors cannot rule out the possibility that clinically significant differences were not detected owing to a lack of statistical power.

Using the nonsupply cost of running the operating room at this institution ($8.30 per operating minute), resident participation added $105.40 to the average phacoemulsification case, or a total cost of $8,293.23 per resident per year. This added intraoperative cost provides a basis for what may be considered a reasonable investment in didactic or surgical simulator training.

The authors note that the cost of an increased number of complications in the earlier months of the academic year was not calculated. Individual supply costs and impact on overtime pay also were not measured. These additional costs emphasize the fact that money invested in teaching outside of the operating room could have a significant impact on the time and money spent during and after cataract surgery performed by residents.