The Impact of Trainee Involvement on Outcomes in Strabismus Surgery

Purpose: To investigate the effect of trainee involvement in strabismus surgery by comparing surgical outcomes of procedures performed solely by attending surgeons to those with trainee involvement. Methods: A retrospective review was performed of 110 patients with esotropia who received bilateral medial rectus recessions (BMR) and 105 patients with exotropia who received bilateral lateral rectus recessions (BLR). Trainee involvement varied from suturing muscle and scleral pass to performing the entire surgery. Success rate was defined as horizontal alignment of less than 10 prism diopters, measured 2 months postoperatively. Rates of reoperation, complications, and postoperative medication use were compared using chi-square tests, with a significance value of P < .05. This study was conducted at Rainbow Babies Children's Hospital at University Hospitals Medical Center in Cleveland, Ohio. Patients were included in the study if the proper surgery documentation was found in the electronic medical record, including primary surgeon, any secondary surgeons, and preoperative and postoperative horizontal alignment. A total of 110 patients with esotropia and 105 patients with exotropia were included in the study. Results: Of the 215 procedures reviewed, 82 were performed solely by attending surgeons and 133 involved trainees. The success rate of attending surgeon–only procedures was 83%, versus 80.5% ( P = .65) for trainee procedures. Of non-trainee cases, 34% of patients needed subsequent surgeries, compared to 22% of trainee-involved cases ( P = .046). Intraoperative complications were found in only one attending surgeon–only procedure and one procedure involving residents ( P = .729). Conclusions: The results showed no significant difference in rates of realignment, complications, and postoperative medication use of BMR and BLR procedures between attending surgeon–only cases and those involving trainees. An increased reoperation rate was seen in the non-trainee group, possibly explained by trainees operating on less complex cases. These data demonstrate that resident/fellow involvement with appropriate supervision is equally safe compared to cases performed by attending surgeons alone, thereby advocating for greater trainee participation in ophthalmic surgeries.