Association of hospital and surgeon operation volume with the incidence of postoperative endophthalmitis: Taiwan experience

Abstract

Purpose To determine the association between hospital and surgeon volume with the incidence of postoperative endophthalmitis. Methods A prospective cohort study was conducted to analyse the national health insurance claims data of those patients receiving cataract surgery in 2000 in Taiwan. A total of 108 705 patients who received cataract surgery by 1004 surgeons at 494 hospitals were followed to the end of 2002. Stepwise Cox regression was used to analyse the effects of hospital and surgeon volume of cataract surgery on postoperative endophthalmitis after adjustment for patient's age, gender, education, ophthalmic comorbidities, general comorbidities, and surgical factors including operative methods, different types of intraocular lenses, and surgeon's age. Results The 2-year incidence of postoperative endophthalmitis at high-volume hospitals (0.90%) was lower than low-volume hospitals (1.16%). The incidence of postoperative endophthalmitis by highvolume surgeons (0.59%) was lower than those by middle-high-volume (0.73%), middle-lowvolume (0.80%), or low-volume surgeons (1.16%). After controlling for case mix, the risk of postoperative endophthalmitis of the lowvolume hospitals (hazard ratio (HR) ¼ 1.39) was higher than that of the high-volume hospitals. The risk of postoperative endophthalmitis of low-volume surgeons (HR ¼ 1.67) was higher than that of the highvolume surgeons. ConclusionsThe provider volume (hospital and surgeon volume) is associated with the risk of postoperative endophthalmitis. The patients who receive cataract surgery at lowvolume hospitals or by low-volume surgeons have significantly higher risk of postoperative endophthalmitis than at high-volume hospitals or by high-volume surgeons. Provider volume can be considered in further postoperative endophthalmitis study as a risk factor. Eye (2006) 20, 900-907.

Visual Outcomes and Associated Risk Factors of Cataract Surgeries in Highly Myopic Taiwanese

“…Moreover, cataract surgery itself has been reported to be a risk factor for RD in highly myopic patients [24], but we could not explain this association either. Although there were no cases that developed endophthalmitis in our study, a study in Taiwan showed that patients who received cataract surgery at low-volume hospitals or by low-volume surgeons had a significantly higher risk of postoperative endophthalmitis than at high-volume hospitals or by high-volume surgeons [16]. Therefore, a more restrictive attitude towards early cataract extraction may be suggested, especially in highly myopic patients.…”

“…In the above-mentioned study in Taiwan, the cataract surgery rate was relatively higher since the implementation of the NHI program [7]. Another study using claim data of the NHI program in Taiwan [16] revealed that there were 108,705 patients receiving cataract surgery in 2000. According to regulations of the NHI program, people are suggested to undergo surgical intervention due to marked cataract with a best-corrected visual acuity >6/12.…”

Visual Outcomes and Associated Risk Factors of Cataract Surgeries in Highly Myopic Taiwanese

“…Moreover, cataract surgery itself has been reported to be a risk factor for RD in highly myopic patients [24], but we could not explain this association either. Although there were no cases that developed endophthalmitis in our study, a study in Taiwan showed patients who received cataract surgery at low-volume hospitals or by low-volume surgeons had significantly higher risk of postoperative endophthalmitis than patients who underwent cataract surgery at high-volume hospitals or by high-volume surgeons [16]. Therefore, a more restrictive attitude towards early cataract extraction may be suggested, especially in highly myopic patients.…”

“…In the above-mentioned study in Taiwan, cataract surgery rate was relatively higher since the implementation of the NHI Program [7]. In another study using claim data of the NHI Program in Taiwan [16], it was reported that there were 108,705 patients receiving cataract surgery in 2000. According to the regulation of the NHI Program, people are suggested to undertake surgical intervention due to marked cataract with a best corrected visual acuity less than 6/12.…”

Incidence of post-cataract endophthalmitis at Aravind Eye Hospital

“…However, that 60% of the SIT endophthalmitis cases arose during the surgeon's first 3 months of training suggests that surgeon inexperience was a contributing risk factor. [25][26][27] In our experience, obstructed nasolacrimal passages and conjunctival microbial colonization are among the most common causes of postsurgical infection after cataract surgery in our patient population. 28 Our operating room protocols, therefore, strive to adequately sterilize the conjunctival surface before surgery.…”