The effect of supervision and out-of-hours surgery on the outcomes of primary macula-on retinal detachments operated by vitreoretinal fellows: A review of 576 surgeries
Author: Walter Andreatta (Switzerland)
Co-authors: George Moussa, Dimitrios Kalogeropoulos, Soon Ch'ng
During Bank Holidays and Weekends (BHWE), many primary macula-on retinal detachments (RD) across the United Kingdom are performed unsupervised by experienced vitreoretinal (VR) fellows. We aimed to determine whether fellows in their first year (F1) and second year (F2) could safety operate out of hours independently with remote supervision on primary macula-on retinal detachments.
The Birmingham and Midlands Eye Centre in the United Kingdom
Retrospective consecutive case series of patients attending Birmingham and Midlands Eye Centre from January 2017-July 2020. We evaluated: i) 6-month retinal re-detachment rate and ii) visual outcomes, of F1, F2 and consultants during office hours and BHWE as well as the effects of supervision (consultant present and scrubbed in the operating theatre) versus non-supervision.
For retinal re-detachment rate, no statistical significance was found between: grade of surgeon (p=0.821), whether supervised (p=1.000), whether BHWE (p=1.000), unsupervised-BHWE and supervised-midweek (p=0.757) and unsupervised F1 and F2 (p=1.000). The lack of significance was maintained across a multivariate Cox survival regression analysis that identified high myopia (p=0.041) and C3F8 vs. C2F6 (p=0.028) as risk factors for re-detachment. No difference was detected in level of supervision (15.7% of all cases) between F1 and F2 during BHWE (p=0.761), mid-week (p=0.295), and overall (p=0.228). No difference was found between surgeon grade and logMAR letters gained pre-postoperatively (p=0.834).
A safe VR service can be provided by experienced VR fellows during office-hours, BHWE, supervised or unsupervised, with similar primary-success and visual outcomes to consultants. In our unit, initial intensive supervision and feedback, followed by a gradually increasing degree of independence are fundamental for VR fellows to gain confidence and become safe independent surgeons.
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