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Association of Cataract Surgical Outcomes With Late Surgeon Career StagesA Population-Based Cohort Study

Educational Objective
To investigate whether an increase in cataract surgical adverse events occurs during later surgeon career stages.
1 Credit CME
Key Points

Question  Are advancing surgeon career stages associated with cataract surgical outcomes?

Findings  In this population-based study of 499 650 cataract operations, a late surgeon career stage was not associated with an increased overall risk of cataract surgical adverse events.

Meaning  These results suggest that cataract surgery can be performed by surgeons at later career stages without increasing the risk of surgical adverse events.


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.

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Article Information

Accepted for Publication: August 24, 2018.

Corresponding Author: Robert J. Campbell, MD, MSc, Department of Ophthalmology, Queen’s University and Kingston Health Sciences Centre, Hotel Dieu Hospital site, 166 Brock St, Kingston, ON K7L 5G2, Canada (rob.campbell@queensu.ca).

Published Online: October 11, 2018. doi:10.1001/jamaophthalmol.2018.4886

Author Contributions: Dr R. Campbell had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: R. Campbell, El-Defrawy, Whitehead, Bell.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: R. Campbell.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: R. Campbell, Whitehead.

Obtained funding: R. Campbell.

Administrative, technical, or material support: El-Defrawy, Gill, Whitehead, E. Campbell, Hooper.

Supervision: R. Campbell, El-Defrawy, Bell.

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Bell receives consulting fees for the Ontario Ministry of Health and Long-Term Care. No other disclosures are reported.

Funding/Support: Dr R. Campbell is supported by the David Barsky chair in Ophthalmology and Visual Sciences. Dr Bell is supported by a Canadian Institutes of Health Research and Canadian Patient Safety Institute chair in Patient Safety and Continuity of Care. This study was supported by the Institute for Clinical Evaluative Sciences, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care.

Role of the Funder/Sponsors: The funding organizations of this study had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and the decision to submit for publication.

Disclaimer: The opinions, results and conclusions reported in this article are those of the authors and are independent from the funding sources. No endorsement by the Institute for Clinical Evaluative Sciences or the Ontario Ministry of Health and Long-Term Care is intended or should be inferred.

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