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Brittany C Tsou,1 Kerry Smith,1 Rahul Shah,1 Fasika A Woreta,1 S Swaroop Vedula,2 Shameema Sikder1 1Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA; 2Malone Center for Engineering in Healthcare, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USACorrespondence: Shameema Sikder, Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore, MD, 21218, USA, Tel +1-240-482-1108, Email ssikder1@jhmi.eduPurpose: 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 &dollar;1393.72 (&dollar;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