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  • Cataract Surgery: Volume and Complications

    By Lynda Seminara
    Selected By: Stephen D. McLeod, MD
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    Journal Highlights

    Ophthalmology, March 2020

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    Using 10-year data from the Swedish National Cataract Register, Zetterberg et al. evaluated cataract surgery volume and compared it with surgical outcomes. They found that the rate of complica­tions dropped as surgeons’ caseloads increased.

    For this retrospective study, the change in operation volume over time was determined for individual surgeons. The annual incidence of capsule com­plications was compared with the op­eration volume of individual surgeons and clinical units. Outcomes of interest included the number of procedures performed, the proportion of capsule complications, and changes in surgical volume and complication rates.

    The analysis showed that the number of surgeons who performed at least 500 procedures per year (defined as “high volume”) rose from 15% to 34% during the study timeline. The proportion of cataract proce­dures performed by high-volume surgeons was 36.9% in 2007, which increased to 68.1% by 2016. The mean annual incidence of capsule complications decreased as the number of per-sur­geon cases increased. In 2016, the rate of these complications was 2.15% for low-volume surgeons (10-99 extractions/ year), 1.32% for medi­um-volume surgeons (100-499 ex­tractions/year), 0.59% for high-volume surgeons, and 0.48% for surgeons who performed at least 1,000 procedures annually. The incidence of capsule complications decreased gradually over time, from 1.5% in 2007 to 0.8% in 2016. No significant correlation was found between the rate of capsule complications and the surgical volume of clinical units.

    The authors noted that while sur­gery for advanced cataracts presents a greater risk for capsule complications, the study was not adjusted for case mix, and higher-volume surgeons operated on patients with better best-correct­ed visual acuity (a surrogate for less advanced cataracts). Moreover, in addition to the potential effect of increased volume, the authors noted that other factors likely contribute to the lower complication rate, including advance­ments in technology and the fact that more patients are undergoing cataract surgery at an early stage of the disease.

    The original article can be found here.