Effect of Resident Involvement in Ophthalmic Surgery on Patient Outcomes: A Systematic Review and Meta-analysis

PURPOSE: To determine the effect of resident-vs attending-led surgeries on patient outcomes in oph-thalmic surgery. center dot DESIGN: Systematic review and meta-analysis.METHODS: Two independent authors searched PubMed, EMBASE, and Cochrane Library from inception to March 2022. Categorical data from studies were pooled to report odds ratio (OR) and 95% CIs. Continuous data were analyzed to yield standardized mean difference (SMD) and 95% CIs. Propensity-matched studies were analyzed separately. Study quality was assessed using the Newcastle-Ottawa Scale.RESULTS: Twenty-four studies were included in this meta-analysis. Seventeen of the 20 outcomes had no significant differences between the 2 cohorts. Notably, many critical cataract surgery-related outcomes showed no significant differences, including posterior capsular tear, lens fragment retainment, and retinal detachment. Among propensity-scored studies, the resident-led surgeries had longer operative duration (SMD 0.81, 95% CI 0.29, 1.33; 3 studies [260 patients], I 2 = 74%) and had an increased risk of an unplanned return to the operating room (OR 2.58, 95% CI 1.31, 5.06; 4 stud-ies [342 patients], I 2 = 0%). Among 2 non-propensity -scored, resident-led surgeries had increased incidence of choroidal detachment or choroidal effusion (OR 2.28, 95% 1.02, 5.09; 2 studies [401 patients], I 2 = 19%). No significant difference was found for ocular hypotony. Significant heterogeneity existed among propensity-scored studies.CONCLUSIONS: Resident-led surgeries appear overall safe, effective, and comparable to attendingled surgeries with respect to commonly encountered perioperative complications. Specific differences in outcomes ex-hibit significant heterogeneity and small sample sizes, and may be of unclear or equivocal clinical significance. (Am J Ophthalmol 2023;249: 144-155. (c) 2023 Elsevier Inc. All rights reserved.)