Opportunity Cost to Attending Surgeons of Intraoperative Training for Residents in Cataract Surgery

Abstract

Purpose

To estimate the opportunity cost to attending surgeons of teaching residents cataract surgery in the operating room.

Patients and methods

Operating room records at an academic teaching hospital from July 2016 to July 2020 were analyzed in this retrospective review of cases. Cases were identified using Current Procedural Terminology (CPT) codes 66982 and 66984 for cataract surgery. Outcomes measured include operative time and work relative value units (wRVUs). Cost analysis was performed using the generic 2021 Medicare Conversion Factor.

Results

Of 8813 cases, 2906 (33.0%) included resident involvement. For CPT 66982 cases, median (interquartile range (IQR)) operative time was 47 (22) minutes with resident involvement and 28 (18) minutes without (p<0.001). For CPT 66984 cases, median (IQR) operative time was 34 (15) minutes with resident involvement and 20 (11) minutes without (p<0.001). Median wRVUs was 78.5 (20.9) with resident involvement and 61.0 (14.4) without (p<0.001) which converted to an opportunity cost (IQR) per case of $1393.72 ($1055.63). Among cases involving residents, median operative time was significantly higher during the first and second quarters (p<0.001) and for every quarter when compared to cases performed by attendings only (p<0.001).

Conclusion

Teaching cataract surgery in the operating room is associated with a considerable opportunity cost for attending surgeons.

Keywords:

• cataract surgery
• resident involvement
• opportunity cost
• relative value units

Acknowledgments

We would like to acknowledge Jing Tian from the Wilmer Biostatistics Core for her assistance with statistical analyses.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This study was supported by grant P30EY01765 (Wilmer Biostatistics Core Grant) from the National Eye Institute, Bethesda, Maryland. Drs. Sikder and Vedula are supported by the National Eye Institute of the National Institutes of Health under award number 1R01EY033065. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.