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  • Surgical Practice Types and Cataract Outcomes

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

    Ophthalmology, June 2021

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    Do surgeons who focus primarily on cataract surgery experience better patient outcomes when compared to colleagues with more diversified sur­gical practices? Campbell et al. set out to explore whether the risk of adverse events related to cataract surgery is affected by a prac­tice’s overall case mix. They found that surgeons with moderate levels of diversifi­cation performed as well as those who focused solely on cataract surgery. However, surgeons whose practices were devoted mostly to other types of ophthalmic surgery were more likely to experi­ence adverse events during cataract surgery.

    This population-based study com-prised all patients ≥66 years of age who had cataract surgery in Ontario, Canada, from January 2002 through December 2013. Their surgeons were classified by the proportion of cataract surgeries performed: 100% cataract (“exclusive”), 1% to 50% other than cataract (“moderately diversified”), or more than 50% other than cataract (“highly diversified”).

    Linked health care databases were used for analyses, along with patient-, surgeon-, and institution-level covari­ates. Surgeon-level covariates included surgical experience and volume. The composite outcome was one of four ad­verse events: posterior capsule rupture, dropped lens fragment, retinal detach­ment, and suspected endophthalmitis.

    Altogether, 1,101,864 cataract operations were performed during the study period. Demographic and clinical traits of patients treated by the various groups of surgeons were comparable at baseline. Adverse events occurred in 0.73% of operations by exclusive cataract surgeons, 0.78% of procedures by moderately diversified surgeons, and 2.31% of cases handled by highly diversified surgeons. The difference in risk of surgery-related adverse events with moderately diversified surgeons versus exclusive cataract surgeons was not significant (odds ratio [OR], 1.08). However, the risk of adverse events was higher in the hands of highly diversi­fied surgeons relative to surgeons who focus primarily on cataract surgery (OR, 1.52; p = .01). This represents an absolute risk difference of 0.016 and a number-needed-to-harm of 64. Results were similar for the sensitivity analy­ses based on surgical experience and volume.

    The authors recommend further study of the relationship between sur­gical focus and outcomes, including the potential for more adverse events with higher diversification and the utility of a cutoff point at which outcomes do become affected.

    The original article can be found here.