Title : Investigating the association between centre surgeon caseload and complication rates in cataract surgery: An analysis of the 2020-2021 royal college of ophthalmologists national ophthalmology database
Abstract:
Background
Cataract surgery is the most frequently undertaken procedure in the NHS. Two significant complications are Posterior Capsule Rupture (PCR) and Visual Acuity (VA) loss. Investigating the risk factors for these complications is vital to improve provision of surgical care. There is an increasing body of evidence supporting that higher volume centres have lower complication rates – it remains unclear whether this also holds true for cataract surgery.
Aim
Determine whether a volume-outcome relationship exists and identify other potential risk factors for complications, in cataract surgery.
Hypothesis
Centres with high surgeon caseload (operations per surgeon per year) have lower complication rates (PCR rates and VA loss rates)
Methods
Data on 134 Trusts was collated from the 2020 National Ophthalmology Database (NOD). The centres were grouped in quartiles of surgeon caseload and compared using Kruskal-Wallis and Chi-squared tests, as appropriate. Adjusted PCR rate and VA loss rate were assessed relative to surgeon caseload and other centre variables using univariable linear regression. Variables approaching significance (P<0.2) were included in a multivariable linear regression.
Results
Data for PCR rates was available for 100% of centres (134/134), and 32.8% of centres (44/134) for VA loss rates. On univariable analysis, surgeon caseload, surgeon experience, pre-operative VA and ocular co-pathology were significantly associated with PCR rate and VA loss rate (p<0.05). On multivariable analysis, higher surgeon caseload was a significant independent predictor of lower adjusted PCR rate (-0.001% per additional operation/surgeon/year, 95%CI: -0.0011 to -0.0001, p = 0.014) and tended towards significance for VA loss rate (-0.001% per additional operation/surgeon/year, 95%CI: -0.002 to 0.000, p = 0.058). Greater surgeon experience was significantly associated with lower PCR rate (p<0.05) and higher pre-operative VA was significantly associated with higher VA loss rate (p<0.05).
Discussion/Conclusions
Centres performing cataract surgery with higher surgeon caseload and a higher percentage of experienced surgeons have statistically significant, yet clinically modest, lower PCR and VA loss rates. This highlights the challenge in balancing the distribution of caseload to train less experienced surgeons and minimising complications. Further research is required to comprehensively assess VA outcomes, with more granular recording of patient and case data.
Audiencetake-away:
- Comprehensive characterization of 134 UK centres
- Data used is taken from the largest UK ophthalmology database
- Findings can underly further research and quality improvement, aiming to reduce complications in cataract surgery.
- Findings can be informative at a managerial level
