Stress during cataract surgery depends on experience level
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WASHINGTON — Stress levels during cataract surgery in a teaching setting depend on the experience of the resident as well as the attending, according to a study.
Timothy W. Grosel, MD, said cataract surgery can be stressful for beginners but gets easier as surgeons gain more experience during residency.
“Supervising resident cataract surgery as an attending can be even more stressful,” he said at the American Society of Cataract and Refractive Surgery meeting. “Attendings usually watch at the side scope and don’t have any actual access to the surgical field or inside the eye.”
Grosel said he and colleagues sought to determine how attending stress levels change over the course of surgery and how they might differ depending on resident experience levels, as well as their own experience.
The study included 13 residents and six attendings and comprised 549 surgeries. Researchers used heart rate as a surrogate for stress by attaching a Bluetooth device to the surgeons’ and attendings’ chests during surgery. They matched that data with video to divide each surgery into eight steps: incision, continuous curvilinear capsulorrhexis, hydrodissection, nucleus disassembly, quadrant removal, cortical cleanup, IOL insertion and closure.
Grosel and colleagues found that the steps with the highest mean attending heart rates were nucleus disassembly and quadrant removal. Attendings had lower mean heart rates across all steps of the procedure compared with residents. However, the difference was significant for only the first six steps.
Attendings with more than 10 years of experience had significantly lower heart rates for the incision, capsulorrhexis, nucleus disassembly, quadrant removal, cortical cleanup and closure steps compared with attendings with 5 years of experience or less.
Grosel said mean heart rates for attendings fell as resident experience with cases increased. However, it began to rise again once residents reached 250 to 299 cases of experience.
“At this point in the training, residents are more comfortable with cataract surgery,” he said. “They’ve developed their own style, and maybe the attendings don’t feel like they have as much influence on how the residents operate.”
Grosel said the findings could be used to help guide attendings when teaching cataract surgery.
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Grosel T. Attending stress levels during the steps of cataract surgery. Presented at: American Society of Cataract and Refractive Surgery meeting; April 22-26, 2022; Washington.
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