Surgeon characteristics associated with post-cataract surgery endophthalmitis in the United States

Abstract

Purpose :
To evaluate endophthalmitis incidence after cataract surgery nationally and to explore physician characteristics associated with increased risk of postoperative endophthalmitis.

Methods :
This was a cross-sectional analysis of all cataract surgeries performed in 2017 for Medicare fee-for-service beneficiaries. Post-operative endophthalmitis was defined by a diagnosis of endophthalmitis within 90 days after cataract surgery. Logistic regression was used to investigate the association between post-operative endophthalmitis and surgeon factors.

Results :
We identified 2,212 cases of post-operative endophthalmitis after 1,669,607 cataract surgeries performed in 2017. The national rate of post-cataract surgery endophthalmitis was 1.32 per 1,000 surgeries (95% confidence interval [CI]: 1.27-1.38 per 1,000). In a multivariate model, surgeries by physicians with lower annual volume of cataract surgery had an increased risk of developing endophthalmitis (adjusted odds ratio [OR] relative to surgeries by surgeons with more than 1000 annual surgeries: 2.88 [95% CI 1.99-4.17] for annual volume of 1 to 50; 1.91 [95% CI 1.39-2.61] for annual volume of 51 to 200; 1.65 [95% CI 1.21-2.25] for annual volume of 201 to 500; and 1.20 [95% CI 0.84-1.70] for annual volume of 501 to 1000). Surgeon’s gender, number of years since medical school graduation, region of practice, population density of practice location, and surgery setting (ambulatory surgical center versus other setting) were not associated with an increased incidence of endophthalmitis. Of the 1,338 surgeons that had one or more cases of endophthalmitis in 2017, the median endophthalmitis rate was 7.5 per 1,000 (1^st quartile 4.2 per 1,000; 3^rd quartile 13.3 per 1,000). 626 surgeons had 2 or more cases of endophthalmitis, and 63 surgeons had 4 or more cases of endophthalmitis in the study year.

Conclusions : Lower annual cataract surgery volume of the surgeon is a significant risk factor for the development of post-cataract surgery endophthalmitis. Further studies are needed to analyze risk factors associated with surgeons with high rates of post-operative endophthalmitis. The creation of a standard benchmark, such as physician-specific endophthalmitis rates, may help surgeons judge their own performance with regard to the national average.

This is a 2020 ARVO Annual Meeting abstract.