New research published in Ophthalmology evaluated postoperative outcomes of U.S. surgeon-level rates and risk factors for endophthalmitis following cataract surgery
Let’s start with some background.
A majority of data on postoperative endophthalmitis complications following cataract surgery have been conducted at population-level and largely centered around patient-related outcomes.
However, research into other surgical specialties (including ophthalmology) have found that postoperative outcomes can be influenced by performance risk factors associated with a physician’s surgical caseload and experience.
Now tell me about this research.
Investigators conducted a retrospective, cross-sectional analysis of Medicare fee-for-service claims data from 2011 to 2019 that involved rates and risk factors of endophthalmitis after cataract surgery based on a surgeon’s level of experience.
Talk data numbers.
The data included a reported 14.4 million cataract surgeries performed by 12,710 ophthalmologists within the 8-year study period. Out of that number, 19,412 patients (> 65 years old) were reported to have developed endophthalmitis within 90 days following their surgery.
Based on the data, the overall 90-day postoperative endophthalmitis rate was 1.36 per 1000 cataract surgeries for all cataract procedures and 1.30 per 1000 cataract surgeries for stand-alone cataract procedures.
The mean surgeon-level rate was 2.1 per 1,000 cataract surgeries.
What else did they find?
Researchers reported an inverse association between total cataract surgery volume and endophthalmitis risk:
- Surgical volume 1: For ≤211 cases, the endophthalmitis rate per surgeon was 2.54.
- Surgical volume 2: For 212 to 656 cases, the endophthalmitis rate per surgeon was 1.79.
- Surgical volume 3: For 657 to 1,487, the endophthalmitis rate per surgeon was 1.55.
- Surgical volume 4: For ≤1,487 cases, the endophthalmitis rate per surgeon was 1.19.
Further, cases performed by surgeons within the surgical volume quartiles 1 to 3 demonstrated 59% (quartile 1); 31% (quartile 2); and 18% (quartile 3) were at increased risk for endophthalmitis compared to those in quartile 4.
Anything else of interest?
Researchers also reported a decreased risk for endophthalmitis after cataract surgeries that were performed by surgeons who graduated within the last 10 years versus those who graduated over 30 years ago.
In the top 20% of cases, high endophthalmitis rates were associated with low cataract surgical volume and a greater number of years in practice.
Significance?
The study authors stated that their findings are consistent with previous research on lower procedural volume and an increased risk for endophthalmitis post-cataract surgery. However, they did note that the new data regarding less time in practice and a lower endophthalmitis risk is contrary to prior findings. They suggested that this may be due to the younger generation of ophthalmologists potentially being more open to adding intracameral antibiotics in their surgical protocols coupled with their fellowship experience, “which have been shown to be a safe and effective method to prevent post-cataract endophthalmitis.”
Any other considerations?
Another variable to consider is the increased trend towards cases performed in an ambulatory surgery center (ASC), which rose from 63.1% in 2011 to 74.9% in 2019.
It could be hypothesized that, with a dedicated staff and surgical team present for consistency and direct oversight of the surgical care delivered to patients, this might influence certain associated risk factors with endophthalmitis rates.
Take home.
The authors concluded that, while endophthalmitis rates vary significantly at surgical levels, their findings support procedural volume as a key indicator for postoperative complications.
They also suggested that further studies are needed to better understand the relationship between surgeon experience and endophthalmitis risk.