Association of Cataract Surgical Outcomes With Late Surgeon Career Stages

Abstract

IMPORTANCE Evidence suggests that the quality of some aspects of care provided by physicians may decrease during their late career stage. However, to our knowledge, data regarding the association of advancing surgeon career phase with cataract surgical outcomes have been lacking. OBJECTIVE To investigate whether an increase in cataract surgical adverse events occurs during later surgeon career stages. DESIGN, SETTING, AND PARTICIPANTS This population-based study of 499 650 cataract operations performed in Ontario, Canada, between January 1, 2009, and December 31, 2013, investigated the association between late surgeon career stage and the risk of surgical adverse events. Linked health care databases were used to study cataract surgical complications while controlling for patient-, surgeon-, and institution-level covariates. All ophthalmologists who performed cataract surgery in Ontario within the study period were included in the analysis. EXPOSURES Isolated cataract surgery performed by surgeons at early, mid, and late career stages. MAIN OUTCOMES AND MEASURES Four serious adverse events were evaluated: dropped lens fragments, posterior capsule rupture, suspected endophthalmitis, and retinal detachment. RESULTS Of 416 502 participants, 244 670 (58.7%) were women, 90 429 (21.7%) were age 66 to 70 years, 111 530 (26.8%) were age 71 to 75 years, 90 809 (21.8%) were age 76 to 80 years, and 123 734 (29.7%) were 81 years or older. Late-career surgeons performed 143 108 of 499 650 cataract operations (28.6%) during the study period. Late surgeon career stage was not associated with an increased overall risk of surgical adverse events (odds ratio [OR] vs midcareer, 1.06; 95% CI, 0.85-1.32). In a sensitivity analysis with surgeon volume removed from the model, late career stage was still not associated with overall adverse surgical events (OR, 1.10; 95% CI, 0.88-1.38). Among individual complications, late surgeon career stage was associated with an increased risk of dropped lens fragment (OR, 2.30; 95% CI, 1.50-3.54) and suspected endophthalmitis (OR, 1.41; 95% CI, 1.01-1.98). These corresponded with small absolute risk differences of 0.11% (95% CI, 0.085%-0.130%) and 0.045% (95% CI, 0.028%-0.063%) for dropped lens fragment and suspected endophthalmitis, respectively. CONCLUSIONS AND RELEVANCE These findings suggest that later-career surgeons are performing a substantial proportion of cataract operations with overall low surgical adverse event rates. Future studies might extend evaluations to the frequency of secondary surgical interventions as additional measures of surgical care quality.

Comparing cataract surgery complication rates in veterans receiving VA and community care

“…Although overall complication rates were low (1.17 percent), the complication rates in high‐risk eyes were over three times higher. Other significant risk factors, similar to those noted previously in the literature, 10‐12,16,18 included complex cataract surgery, black race, and rurality 40 . Although the presence of preoperative ocular conditions was positively associated with higher complication rates (though this association was not statistically significant), once risk category was added to the model, there was a lower risk of complications among patients with 1‐2 preoperative ocular conditions compared to those with none.…”

“…Third, cataract surgery has well‐defined outpatient postoperative complications that can be easily obtained using administrative data, thereby making comparisons across health care settings feasible. Fourth, although cataract surgery is considered relatively safe and effective, 11 with low complication rates compared to other procedures (reported rates range from 0.5%‐3.0%), 10,16‐19 studies have found differences in complication rates following cataract surgery across settings of care. For example, when comparing Veterans 65 and older who received cataract surgery in VA compared to the private sector under Medicare, French et al found that complication rates in the VA were 50 percent higher than those in the private sector 18 .…”

Cataract Surgery Quality and Capacity

“…The Provincial Vision Task Force and its associated Cataract Expert Committee have created guidelines outlining highquality clinical care processes (Ontario Ministry of Health and Long-Term Care 2018). Overall, our research has demonstrated excellent outcomes for patients undergoing cataract surgery in Ontario, with adverse event rates among the lowest reported worldwide (Campbell et al 2017b(Campbell et al , 2019. To further support the quality agenda, our research program investigated surgeonlevel factors that may influence the quality of cataract surgery, including surgeon career stage, surgical volume and diversity of practice.…”

“…However, evidence regarding the technical proficiency of surgeons at later career stages is inconclusive (Blasier 2009;Chai et al 2010;Choudhry et al 2005;Hartz et al 1999;O'Neill et al 2000;Prystowsky 2005;Prystowsky et al 2002;Waljee et al 2006). To address this issue, we conducted a population-based study to evaluate the effect of late surgeon career stage on the risk of cataract surgical complications (Campbell et al 2019). Early-, mid-and latecareer stages were defined, respectively, as fewer than 15 years, 15-25 years and more than 25 years since the conclusion of undergraduate medical training.…”

Clinical Characteristics and Outcomes in 314 Japanese Patients with Bacterial Endophthalmitis: A Multicenter Cohort Study from J-CREST

“…Bacterial endophthalmitis is classified into two groups on the basis of the infection route (exogenous or endogenous). Exogenous endophthalmitis (ExE) is mainly caused by eye surgery [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ] and trauma [ 24 , 25 , 26 ] due to the direct infection of pathogens into the eye from outside. Acute endophthalmitis appears as a postoperative complication within 1–2 weeks after the surgical intervention, most commonly on the third to fifth postoperative day [ 1 , 2 ].…”