JAMA Ophthalmology, January 2019
Some evidence suggests that the quality of patient care may be lower in the latter stages of a physician’s career. Of particular concern is the technical proficiency of surgeons, given the neurophysiologic changes that occur naturally with aging. In a large population-based study that addressed this matter for cataract surgery, Campbell et al. found no correlation between late career stage and the risk of adverse surgical events.
The study included data for 499,650 cataract operations performed in Ontario, Canada, from 2009 through 2013, which represented all ophthalmologists who performed the surgery in the province during this period. Linked health care databases were used to study cataract surgery complications while controlling for patient-, surgeon-, and institution-level covariates. The authors focused on four serious adverse events: dropped lens fragments, posterior capsular rupture, suspected endophthalmitis, and retinal detachment. Surgeons were grouped by career level, with early-, mid-, and late-career phases defined as <15 years of experience, 15-25 years of experience, and >25 years of experience, respectively.
Random-effects logistic regression models were used to evaluate the association between late-career stage and the risk of adverse events, controlling for both patient-level and surgeon-level covariates and for institution type. In a secondary analysis, surgeon age was the variable of interest. Analyses were adjusted for secular trends.
During the study period, late-career surgeons performed 143,108 (28.6%) of the surgeries, and their work was not associated with higher overall risk of surgical adverse events (odds ratio [OR], 1.06 vs. midcareer surgeons). In a sensitivity analysis in which surgeon volume was removed from the model, the result was similar (OR, 1.10). An association was observed between late career stage and the risk of suspected endophthalmitis (OR, 1.41) and dropped lens fragment (OR, 2.30).
The authors noted that, in future studies, it may be worthwhile to consider the frequency of secondary surgery as another indicator of the quality of primary surgical care.
The original article can be found here.