住院医师参与白内障手术对手术时间和费用的影响

Objective:

To investigate the impact of resident participation in cataract surgery on operative time and cost.

Design:

Retrospective chart review.

Participants:

All patients who underwent phacoemulsification cataract surgery by an attending or resident surgeon of the Penn State Hershey Eye Center between July 1, 2004, and June 30, 2007.

Methods:

Operating room records of all phacoemulsification surgeries performed at a single academic center between July 1, 2004, and June 30, 2007, were reviewed.

Main Outcome Measures:

Operative case length in minutes and cost of operating room time.

Results:

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 41 seconds longer per eye when performed by a senior resident compared with an attending surgeon (95% confidence interval [CI], 1 minute 48 seconds to 23 minutes 35 seconds; P=0.027). Resident cases averaged 63 minutes in July, and decreased to an average of 27 minutes in June. Every month from July through December of the academic year, the monthly mean operative case length for resident cases was significantly longer than the mean operative case length for attending cases (P<0.05), except November, when the difference was borderline significant (95% CI, −23 seconds to 23 minutes 9 seconds; P=0.057). From January through June, there was no difference. Using the nonsupply cost of running the operating room at our institution ($8.30 per operating minute), resident participation added $105.40 to the average phacoemulsification case. This cost totaled $8293.23 per resident per year.

Conclusions:

Resident participation is associated with significantly increased phacoemulsification operative times and costs during the first half, but not the second half, of the academic year. The time and cost per resident may be important to consider when allocating resources for preclinical training.