Outcomes of Strabismus Surgery with or without Trainee Participation as Surgeon

Patient outcomes following carotid endarterectomy are not adversely affected by surgical trainees' operative involvement: A retrospective cohort study

Background

Surgical training is an increasingly controversial topic. Concerns have been raised about both training opportunities becoming scarcer and poorer outcomes in operations led by surgical trainees; despite the evidence base for this being mixed. This retrospective cohort study aims to compare outcomes following carotid endarterectomy in patients who were operated on by a surgical trainee to those operated on by consultants.

Materials and methods

Consecutive patients, who underwent carotid endarterectomy between 01/06/2012 and 1/12/2016, were entered into a prospectively maintained database. Patients were grouped according to whether a consultant or trainee vascular surgeon was the lead operating surgeon. Outcomes were 30-day mortality, 30-day stroke rate, operation time and complication rate.

Results

One-hundred-and-twenty-one patients, with a mean age of 70.3 years, underwent carotid endarterectomy over a 4.5-year period. They were classified by the grade of the lead operating surgeon: consultant (n = 74) or registrar (n = 47). The median operative time was 117 min for consultants and 115 min for registrars with no significant difference between the two groups (p = 0.78). Three patients died in the post-op period, 2 secondary to post-operative stroke and a further 5 had nonfatal strokes. Grade of surgeon was also found to have no impact on 30- day mortality (p = 0.99) or stroke rate (p = 0.99). Sixty-six patients experienced post-operative complications, of varying severity, but no significant difference (p = 0.66) was found in incidence between trainee (57%) and consultant (53%) groups.

Conclusion

Trainee involvement in carotid endarterectomy, with consultant supervision, leads to equivalent outcomes and represents a safe and useful training opportunity.

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There is a paucity of contemporary research assessing the safety of trainee involvement in carotid endarterectomy.

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Complication rates were higher for trainees but major complications were more common with consultant led operations.

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30-day mortality is slightly higher in patients operated on by a consultant but not significantly so.

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Carotid endarterectomy can represent a safe and useful training opportunity for an appropriately supervised trainee.

Parent attitudes toward resident involvement in their child's strabismus surgery

PURPOSE

To explore patterns in parents' understanding and preferences related to ophthalmology resident participation in their child's strabismus surgery.

METHODS

Over a 4-week period, a survey was distributed at a suburban, academic eye center to English-speaking parents of children with strabismus who have not previously undergone, or were not being scheduled for, strabismus surgery.

RESULTS

All of the 64 eligible parents participated in the survey. For a resident to assist or perform the surgery, 80% and 97% of parents, respectively, indicated it was important or extremely important to be asked permission beforehand; 69% indicated the attending surgeon should ask permission for the resident to perform the surgery, whereas only 11% believed a standard written consent was sufficient. Of the 64 respondents, 77% indicated that they would agree to a resident assisting with their child's operation; 36% would agree to a resident performing the surgery.

CONCLUSIONS

Nearly all parents in our study indicated that they would want to be informed of resident involvement by the attending surgeon. The vast majority would consent to having an ophthalmology resident assist in their child's strabismus surgery, and more than one-third would consent to having the resident perform their child's strabismus surgery. Obtaining informed consent prior to resident involvement increases transparency and highlights the importance of ophthalmology residency education.

Prognostic preoperative factors for successful outcome of surgery in horizontal strabismus

CONTEXT

Surgery for horizontal strabismus reportedly has a success rate of 60%-80%. However, which preoperative factors are predictive of this success is not clear.

AIMS

To identify prognostic factors those are predictive of successful outcome in horizontal strabismus surgery.

SETTINGS AND DESIGN

Observational analytical study using multiple logistic regression (MLR).

SUBJECTS AND METHODS

We assessed the medical records of patients who had undergone first-time horizontal muscle strabismus surgery between 2002 and 2013, where complete follow-up data were available for ≥6 weeks, and also, we collected data prospectively on patients operated between January 2014 and September 2015. Successful outcome was defined as a postoperative angle of deviation within 10 prism diopter of orthophoria at ≥6 weeks postoperatively. Independent variables considered were age at onset, age at surgery, duration, gender, deviation - type and amount, logMAR visual acuity (VA) - mean and of the poorer eye, mean refractive error, amount of anisometropia, and presence of dense amblyopia. Only those with P < 0.2 on univariate analyses (UAs) were included in the MLR, with significance set at P ≤ 0.05.

STATISTICAL ANALYSES

UA (Chi-square for categorical variables and t-tests for continuous variables), followed by logistic regression analysis.

RESULTS

Of 113 patients, on UA, type of deviation (P = 0.01), age at surgery (P = 0.16), absence of dense amblyopia (P = 0.002), and logMAR VA of the poorer eye (P = 0.005) qualified for the inclusion in MLR. On MLR, esotropia (ET) (odds ratio [OR]: 4.46) and absence of dense amblyopia (OR: 5.90) were associated with success.

CONCLUSIONS

With an overall success rate of 83%, ET and absence of dense amblyopia were significantly predictive of surgical success.

One-Year Progress in Ophthalmic Education: Annual Review

PURPOSE

The aim of this study was to update the practicing ophthalmologist on the English language literature about medical education from the prior year.

DESIGN

A search of English language literature was performed on PubMed from January 1, 2014, to December 31, 2014.

METHODS

Because the search using the main topic of the review "medical education" came up with 7394 citations, authors finally decided to narrow the search to 3 topics of their interest:1. Current state of competency-based education and teaching methods of competencies. This section included ophthalmic/ophthalmology education, core competencies, competency-based education, teaching strategies, tools and methods in medical education.2. E-learning. This section included e-learning, online learning, online teaching, Web-based teaching, Web-based learning, and flipped classroom.3.

ASSESSMENTS

This section included assessment of medical students, residents, fellows, faculty, attending physicians, and medical teachers, assessment of medical student ophthalmology programs, ophthalmology residency programs, residency programs, and fellowship programs.

RESULTS

The authors reviewed and summarized articles published in 2014 examining or describing the 3 main areas of the review described previously.

CONCLUSIONS

This review updates the comprehensive ophthalmologist on advances in ophthalmic medical education. Ophthalmic educators could apply the ideas presented in this review according to their possibilities in their own settings and programs.