Cataract surgery complications appear more common among highly diversified surgeons

This retrospective, population-based cohort study evaluated the effect of surgical practice focus on cataract surgical outcomes.

Study design

Using a national healthcare population-based database, researchers evaluated outcomes of 1,101,864 operations performed by 486 surgeons in Ontario, Canada, during a 10-year period. Cataract surgeons were divided into those exclusively performing cataract surgery, moderately diversified surgeons (1%–50% noncataract procedures) and highly diversified surgeons (>50% noncataract procedures).

Outcomes

The risk of adverse surgical events was relatively low and similar between exclusively cataract surgeons and moderately diversified surgeons. However, highly diversified cataract surgeons had a 2.3% incidence of adverse events, which was significantly higher than events in the other groups.

Limitations

The large sample size and population-based methodology are strengths of this study. However, the number of surgeons in the highly diversified group was dramatically smaller than those in the other study groups. These surgeons also performed fewer cataract surgeries, possibly introducing confounding bias. A larger group of highly diversified surgeons would help support the conclusions of the study.

Clinical significance

This study evaluates surgical specialization and its impact on the outcomes of cataract surgery. Previous studies have demonstrated that surgeons with higher volumes of cataract surgeries have significantly lower complication rates. Findings from this study indicate that cross-specialization does not lead to higher adverse outcomes as long as the majority of cases (>50%) are cataract cases. Surgeons with practices dedicated to noncataract surgery may have higher complication rates, which should be considered when developing both individual and group practice patterns.