Exclusive surgical focus does not affect safety of cataract surgery

Surgeons’ exclusive surgical focus appears to have no impact on the safety of cataract surgery as opposed to moderate levels of surgical diversification, a study has found. However, the risk of cataract surgical adverse events is greater among surgeons dedicated mainly to noncataract operations.

All patients aged ≥66 years undergoing cataract surgery in Ontario, Canada, between 1 January 2002 and 31 December 2013 were included in this population-based cohort study.

Linked healthcare databases and controlling for patient-, surgeon-, and institution-level covariates were used to assess the outcomes of isolated cataract surgery carried out by exclusive cataract surgeons (no other types of surgery performed), moderately diversified cataract surgeons (1–50-percent noncataract procedures), and highly diversified cataract surgeons (>50-percent noncataract procedures). Both surgeon experience and surgical volume were included in surgeon-level covariates.

A total of 1,101,864 cataract operations were included. The median age of patients was 76 years, and 60.2 percent were female. Three groups of surgeons treated these patients, which had similar characteristics at baseline.

Adverse events occurred in 0.73 percent of cases operated on by exclusive cataract surgeons, 0.78 percent by moderately diversified surgeons, and 2.31 percent by highly diversified surgeons. The risk of cataract surgical adverse events was comparable between patients operated on by moderately diversified surgeons and by exclusive cataract surgeons (odds ratio [OR], 1.08, 95 percent confidence interval [CI], 1.00–1.18).

On the other hand, the risk of adverse events was higher in patients operated on by highly diversified surgeons than by exclusive cataract surgeons (OR, 1.52, 95 percent CI, 1.09–2.14). The absolute risk difference was 0.016 (95 percent CI, 0.012–0.020), while the number needed to harm was 64 (95 percent CI, 50–87).