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CC BY-NC-ND 4.0 · Journal of Academic Ophthalmology 2021; 13(02): e119-e123
DOI: 10.1055/s-0041-1735594
Research Article

Evolution of a Glaucoma Fellow's Surgical Training: Improvements in Tube Shunt Case Times during the Academic Year

Cason B. Robbins 
1   Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
,
Khalid Aldaas
2   Department of Ophthalmology, University of North Carolina, Chapel Hill, North Carolina
,
Sanjay Asrani
1   Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
,
Stuart McKinnon
1   Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
,
David Fleischman
2   Department of Ophthalmology, University of North Carolina, Chapel Hill, North Carolina
,
Divakar Gupta
1   Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
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Abstract

Purpose The aim of the study is to report changes in tube shunt placement surgical case times for glaucoma fellows during the course of the academic year.

Patients and Methods Electronic health records were retrospectively reviewed to determine patient demographics, surgical case times (defined as procedure start time to procedure end time), and glaucoma fellow involvement. Only cases with a glaucoma fellow as the primary surgeon were included. Operative case times were compared by first and second halves of the academic year (beginning in July and ending in June) using a two-tailed t-test.

Results Five hundred and seventy-three individual tube shunt surgeries (385 Ahmed, 188 Baerveldt) performed by 28 glaucoma fellows (17 females, 11 males) at Duke University Eye Center and University of North Carolina Medical Center were included. Overall, case times were significantly shorter in the second half of the academic year as compared with the first (55.3 ± 17.1 minutes vs. 61.0 ± 17.4 minutes, p <0.001). Both male (57.3 ± 16.8 minutes vs. 63.2 ± 18.6 minutes, p = 0.008) and female (53.5 ± 17.3 minutes vs. 59.3 ± 16.4 minutes, p = 0.003) fellows demonstrated shorter case times over the academic year; additionally, female fellows trended toward shorter case times than male fellows in both the first half (p = 0.072) and second half (p = 0.053) of the academic year. Fellows also exhibited shorter case times with both Ahmed implants (54.1 ± 16.2 minutes vs. 59.3 ± 15.8 minutes, p = 0.002) and Baerveldt implants (57.8 ± 18.9 minutes vs. 64.2 ± 20.0 minutes, p = 0.025) cases over the academic year. Baerveldt case times were significantly longer than Ahmed cases in the first half (p = 0.028) and trended toward being longer than Ahmed cases in the second half (p = 0.070).

Conclusion Across 5 years at two academic institutions, glaucoma fellows had shorter primary tube shunt surgical case times in the second half of the academic year. These findings reflect improvement in surgical efficiency throughout glaucoma fellowship. These findings should be taken into consideration when scheduling trainee surgeries at academic medical centers at different points in the academic year.

Keywords

glaucoma - surgery - tube shunt - Ahmed - Baerveldt - fellows - surgical education

Précis

This retrospective analysis of glaucoma fellows at two academic institutions over a 5-year period demonstrates that surgical tube shunt case times decrease over the academic year. These findings may be used to guide operative scheduling of trainee surgical cases at academic centers.


Financial Support

None.




Publication History

Received: 08 April 2020

Accepted: 05 August 2021

Article published online:
10 November 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Belyea DA, Brown SE, Rajjoub LZ. Influence of surgery simulator training on ophthalmology resident phacoemulsification performance. J Cataract Refract Surg 2011; 37 (10) 1756-1761
    CrossrefPubMedGoogle Scholar
  • 2 Abe RY, Shigueoka LS, Vasconcellos JPC, Costa VP. Primary trabeculectomy outcomes by glaucoma fellows in a tertiary hospital in Brazil. J Glaucoma 2017; 26 (11) 1019-1024
    CrossrefPubMedGoogle Scholar
  • 3 Biggerstaff KS, Vincent RD, Lin AP, Orengo-Nania S, Frankfort BJ. Trabeculectomy outcomes by supervised trainees in a veterans affairs medical center. J Glaucoma 2016; 25 (08) 669-673
    CrossrefPubMedGoogle Scholar
  • 4 Kang JM, Padmanabhan SP, Schallhorn J, Parikh N, Ramanathan S. Improved utilization of operating room time for trainee cataract surgery in a public hospital setting. J Cataract Refract Surg 2018; 44 (02) 186-189
    CrossrefPubMedGoogle Scholar
  • 5 Karaconji T, Mercieca K, Romera P, McNaught A, Anand N. A comparison of deep sclerectomy trainer versus trainee outcomes. J Glaucoma 2019; 28 (05) 427-432
    CrossrefPubMedGoogle Scholar
  • 6 Walkden A, Huxtable J, Senior M. et al. Trabeculectomy training in England: are we safe at training? Two-year surgical outcomes. Eye (Lond) 2018; 32 (07) 1253-1258
    CrossrefPubMedGoogle Scholar
  • 7 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 (02) 53-58
    CrossrefPubMedGoogle Scholar
  • 8 Liebman DL, McKay KM, Haviland MJ, Moustafa GA, Borkar DS, Kloek CE. Quantifying the educational benefit of additional cataract surgery cases in ophthalmology residency. J Cataract Refract Surg 2020; 46 (11) 1495-1500
    CrossrefPubMedGoogle Scholar
  • 9 Wiggins MN, Warner DB. Resident physician operative times during cataract surgery. Ophthalmic Surg Lasers Imaging 2010; 41 (05) 518-522
    CrossrefPubMedGoogle Scholar
  • 10 Taravella MJ, Davidson R, Erlanger M, Guiton G, Gregory D. Characterizing the learning curve in phacoemulsification. J Cataract Refract Surg 2011; 37 (06) 1069-1075
    CrossrefPubMedGoogle Scholar
  • 11 Childers CP, Maggard-Gibbons M. Understanding costs of care in the operating room. JAMA Surg 2018; 153 (04) e176233
    CrossrefPubMedGoogle Scholar
  • 12 Winter TW, Olson RJ, Larson SA, Oetting TA, Longmuir SQ. Resident and fellow participation in strabismus surgery: effect of level of training and number of assistants on operative time and cost. Ophthalmology 2014; 121 (03) 797-801
    CrossrefPubMedGoogle Scholar
  • 13 Farnworth LR, Lemay DE, Wooldridge T. et al. A comparison of operative times in arthroscopic ACL reconstruction between orthopaedic faculty and residents: the financial impact of orthopaedic surgical training in the operating room. Iowa Orthop J 2001; 21: 31-35
    PubMedGoogle Scholar
  • 14 Sasor SE, Flores RL, Wooden WA, Tholpady S. The cost of intraoperative plastic surgery education. J Surg Educ 2013; 70 (05) 655-659
    CrossrefPubMedGoogle Scholar
  • 15 Ramulu PY, Corcoran KJ, Corcoran SL, Robin AL. Utilization of various glaucoma surgeries and procedures in Medicare beneficiaries from 1995 to 2004. Ophthalmology 2007; 114 (12) 2265-2270
    CrossrefPubMedGoogle Scholar
  • 16 Chadha N, Liu J, Teng CC. Resident and fellow glaucoma surgical experience following the tube versus trabeculectomy study. Ophthalmology 2015; 122 (09) 1953-1954
    CrossrefPubMedGoogle Scholar
  • 17 Chadha N, Warren JL, Liu J, Tsai JC, Teng CC. Seven- and eight-year trends in resident and fellow glaucoma surgical experience. Clin Ophthalmol 2019; 13: 303-309
    CrossrefPubMedGoogle Scholar
  • 18 Gedde SJ, Schiffman JC, Feuer WJ, Herndon LW, Brandt JD, Budenz DL. Tube versus Trabeculectomy Study Group. Treatment outcomes in the tube versus trabeculectomy (TVT) study after five years of follow-up. Am J Ophthalmol 2012; 153 (05) 789-803.e2
    CrossrefPubMedGoogle Scholar
  • 19 Gedde SJ, Feuer WJ, Lim KS. et al; Primary Tube Versus Trabeculectomy Study Group. Treatment outcomes in the primary tube versus trabeculectomy study after 3 years of follow-up. Ophthalmology 2020; 127 (03) 333-345
    CrossrefPubMedGoogle Scholar
  • 20 Gupta D, Taravati P. Effect of surgical case order on cataract surgery complication rates and procedure time. J Cataract Refract Surg 2015; 41 (03) 594-597
    CrossrefPubMedGoogle Scholar