New surgeons more likely to have high complication rates for cataract surgery

30/01/2017

Surgeons who perform cataract surgery in their first year of practice were over nine times more likely to have high complication rates than surgeons in their tenth year of practice according to a new study from the Institute for Clinical Evaluative Sciences (ICES).

In the study published in Ophthalmology, the researchers examined 1,431,302 cataract surgeries in patients 66 years of age or older from January 1, 1997 to December 31, 2013. The surgeries were performed by 144 surgeons in Ontario and the study looked at four serious complications of cataract surgery: posterior capsule rupture, dropped lens fragments, retinal detachment and suspected endophthalmitis (severe inflammation of the tissues inside the eye).

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The researchers note that during the study period less than one per cent of cataract operations resulted in one of the adverse events however some surgeons in their first year of practice had complications in more than 2 per cent of the cataract surgeries they performed.

Cataract surgery is the most frequently performed surgical procedure in Canada, the US and most developed countries.

“The need to train new surgeons is an essential part of a sustainable healthcare system. However, the results of this study suggest that cataract surgical complications are significantly more likely early in a surgeon's independent practice career. While the majority of new surgeons have excellent complication rates, ongoing innovations may be needed both in surgical training and early career monitoring and mentoring processes to address those that don’t and ensure patient safety while continually renewing the surgical workforce,” says Dr. Rob Campbell, scientist at ICES and an ophthalmologist at the School of Medicine at Queen’s University.

Key findings from the study:

Surgeons in their first year of independent practice were over nine times more likely to have high complication rates (≥2 per cent) than surgeons in their tenth year
Each additional year of surgeon experience was associated with a 10 per cent decrease in risk of serious complications
Over the study period, 9,932 (0.7 per cent) of cataract operations resulted in one of the adverse events

“Although we used cataract surgery as a model for this study, many surgical fields place similarly intense skill acquisition demands on trainees and the outcomes we observed may be reflective of issues facing many technically challenging surgical fields,” says Campbell.

The study “New surgeon outcomes and the effectiveness of surgical training: a population-based cohort study” was published in Ophthalmology.

Author block: Robert J. Campbell, Sherif R. El-Defrawy, Sudeep S. Gill, Marlo Whitehead, Erica de L.P. Campbell, Philip L. Hooper, Chaim M. Bell and Martin ten Hove.

The Institute for Clinical Evaluative Sciences (ICES) is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on Twitter: @ICESOntario