Katarakt Cerrahisi Öğrenme Eğrisi: Asistanların Cerrahi Sonuçlarının ve Komplikasyonların Deneyime Göre Değerlendirilmesi

Abstract

Bu çalışmanın amacı asistanların katarakt cerrahisi öğrenme eğrilerini ve cerrahi sonuçlarını retrospektif olarak değerlendirmektir. Eylül 2019 ile Ocak 2021 tarihleri arasında 3 asistan tarafından fakoemülsifikasyon ameliyatı yapılan 301 hastanın 339 gözü retrospektif olarak incelendi. Olgular asistanların cerrahi eğitime başladıkları dönem (ilk altı ay - ilk dönem, n = 83) ve deneyim kazandıkları dönem (son 6 ay - ikinci dönem, n = 256) iki gruba ayrıldı. Hastaların demografik özellikleri, eşlik eden hastalıkları, ameliyat sırasında ve sonrasında gelişen komplikasyonlar, en iyi düzeltilmiş görme keskinliği kazanımları istatistiksel olarak analiz edildi. Cerrahi sonuçlar gruplar arasında ve ayrıca komplikasyon varlığına göre istatistiksel olarak karşılaştırıldı. Komplikasyon oranı ilk dönemde %19,3, ikinci dönemde %6,2 idi (p<0,001). Asistanların ameliyatın tüm aşamalarını tamamlama oranı birinci dönemde %66,3 iken, ikinci dönemde bu oran %96,9'a yükseldi (p<0,001). Her iki dönemde de postoperatif EİDGK artışı istatistiksel olarak anlamlı bulunmuştur (p<0,001); ortalama preoperatif ve postoperatif değerler sırasıyla 0,17 ± 0,16 ve 0,53 ± 0,34’tür. Komplikasyon gelişen ve gelişmeyen gözlerde EİDGK kazancı benzer bulundu (p = 0,430). Öte yandan ek oküler hastalığı olan gözlerde EİDGK kazancı, oküler hastalığı olmayan gözlere göre anlamlı derecede düşük bulundu (p=0,015). Katarakt cerrahisi eğitimi sırasında ameliyatı yardımsız tamamlama oranı eğitim süresiyle orantılı olarak artarken komplikasyon oranı azalmaktadır. Asistanların cerrahi eğitiminin, komplikasyon gelişiminden bağımsız olarak, görme keskinliği açısından güvenilir olduğu bulundu.

Keywords

• öğrenim eğrisi
• komplikasyon
• katarakt
• cerrahi
• fakoemülsifikasyon
• eğitim

Cataract Surgery Learning Curve: Evaluation of Residents' Surgical Outcomes and Complications Based on Experience

Abstract

This study aims to retrospectively evaluate the cataract surgery learning curves and surgical outcomes of residents. Between September 2019 and January 2021, 339 eyes of 301 patients who underwent phacoemulsification surgery by 3 residents were retrospectively examined. The cases were categorized into two groups: the initial six months of training (first six months - first term, n = 83) and during the period when they gained experience (last 6 months - second term, n = 256). Demographic characteristics of the patients, comorbidities, complications, and changes in BCVA were statistically analyzed. Surgical outcomes were compared statistically between the groups. The complication rate was 19.3% in the first term and 6.2% in the second period (p<0.001). While the completion rate of all stages of surgery by residents was 66.3% in the first term, this rate increased to 96.9% in the second term (p<0.001). Postoperative improvement in BCVA was statistically significant in both terms (p<0.001), with mean preoperative and postoperative values of 0.17 ± 0.16 and 0.53 ± 0.34, respectively. Postoperative improvement in BCVA was similar in eyes that developed and did not develop complications (p = 0.430). Conversely, BCVA gain in eyes with additional ocular comorbidities was significantly lower than in eyes without ocular disease (p = 0.015). The rate of completing surgery without assistance during cataract surgery training increases in proportion to the training period, while the complication rate decreases. Surgical training of residents was found to be reliable for the outcome visual acuity, regardless of the development of complications.

Keywords

• learning curve
• complication
• cataract
• surgery
• phacoemulsification
• education

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