The Cataract National Dataset Electronic Multi-centre Audit of 55 567 Operations: variation in posterior capsule rupture rates between surgeons

Abstract

Aims To demonstrate variations in posterior capsule rupture (PCR) rate between surgeons of the same and different grades as a by-product of routine clinical care. Method NHS departments using electronic medical record (EMR) systems to collect the Cataract National Dataset (CND) were invited to submit data. Data were remotely extracted, anonymised, assessed for conformity and completeness, and analysed for rates of PCR for individual surgeons within each of the three grades. Results Data were extracted on 55 567 cataract operations performed at 12 NHS trusts by 406 surgeons between November 2001 and July 2006. Data on the grade of 404 of the 406 surgeons who contributed to the study were available for 55 515 cases (99.9%) and were used for this analysis. Variation in PCR rate between surgeons was highest for the most junior grade of surgeon and between those surgeons contributing relatively few cases to the data set. Variation in PCR was lowest among experienced surgeons contributing large numbers of cases to the data set. Conclusions Considerable variation in PCR rate exists both between and within surgical grades. Routine electronic collection of the CND allows detailed analysis of variations in PCR rates between individual surgeons. To define acceptable limits for this benchmark complication of cataract surgery, further work is needed to adjust surgeons' outcomes for the case mix complexity.

United Kingdom National Ophthalmology Database Study: Diabetic Retinopathy; Report 1: prevalence of centre-involving diabetic macular oedema and other grades of maculopathy and retinopathy in hospital eye services

“…This project builds on a series of studies where clinicians have pooled EMR data to update benchmark standards for cataract and vitreo-retinal surgery. [15][16][17][18][19] …”

The cataract national data set electronic multi-centre audit of 55 567 operations: case-mix adjusted surgeon's outcomes for posterior capsule rupture

“…[3][4][5][6][7][8] Of particular relevance to the present report is our previous finding that based on routine preoperatively collected data, the predicted probability of a complication during surgery may vary by 100 fold from 0.75% for the most straightforward lowest-risk cases to over 75% for the highest-risk most complex cases. 5 Furthermore the grade of surgeon has an important influence on the likelihood of a complication arising.…”

Royal College of Ophthalmologists' National Database Study of Vitreoretinal Surgery

“…6 There has been recent interest in physician-level outcomes being visible to the public in Europe and North America among different specialities, including ophthalmology. 7,8 The primary objective is to create a tool that will drive service improvement and improve patient safety. Physicians will be able to benchmark their performance, reflect on their practice and increase their accountability to the public who may be able to confirm whether a particular individual is performing within acceptable boundaries.…”