Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland.
Aravind Eye Hospital, Madurai, Tamil Nadu, India.
Ophthalmology. 2019 Nov;126(11):1480-1489. doi: 10.1016/j.ophtha.2019.03.033. Epub 2019 Apr 9.
The primary objective was to assess associations between annual surgeon case volume and visual acuity outcomes after cataract surgery. Secondary objectives included (1) assessing associations between other case and patient characteristics and visual acuity outcomes and (2) assessing associations between annual surgeon case volume and complication rates.
Database study.
All adult eyes that underwent small-incision cataract surgery (SICS) or phacoemulsification cataract extraction (PECE) with intraocular lens placement at the Aravind Eye Hospital, Madurai, India, during 2015.
Descriptive statistics were used to characterize the study population. Uncorrected visual acuity (UCVA) at follow-up was assessed relative to annual surgeon case volume and other case and demographic factors using bivariate linear regression with random effects modeling. Factors with P values of less than 0.20 on bivariate regression were included in multivariate linear regression with random effects modeling.
Postoperative UCVA after cataract surgery.
Of 91 084 surgeries, 35 880 eyes were included in this study. Cases were performed by 69 surgeons, who varied in annual case volume from 76 to 2900 cases during the study period. Increasing annual surgeon case volume was independently associated with a statistically significant but clinically modest improvement in UCVA in PECE but not in SICS. This association was most pronounced when comparing surgeons with case volumes of 350 PECE/year or fewer; surgeons with more than 350 PECE/year had similar results to one another. Similarly, increased annual case volume was associated with significantly lower complication rates, both in PECE and SICS. Younger patient age was independently associated with improved visual acuity outcomes and lower complication rates in both PECE and SICS. Greater surgeon experience was associated with lower complication rates in PECE, but not SICS, and there was no significant association with visual acuity outcomes.
High-volume cataract surgeons showed improved visual acuity outcomes in PECE and lower complication rates in PECE and SICS. These findings further support the benefit of high-output ophthalmology clinics wherein individual surgeons perform a high number of cataract extractions annually, particularly in developing nations where there is a large backlog of untreated cataracts and the cataract patient-to-surgeon ratio is high.
主要目的是评估白内障手术后每年外科医生手术量与视力结果之间的关系。次要目标包括：(1)评估其他病例和患者特征与视力结果之间的关系，以及(2)评估每年外科医生手术量与并发症发生率之间的关系。
数据库研究。
在印度 Madurai 的 Aravind 眼科医院接受小切口白内障手术(SICS)或超声乳化白内障吸除术(PECE)联合人工晶状体植入的所有成年眼，纳入研究的时间为 2015 年。
采用描述性统计方法对研究人群进行特征描述。使用具有随机效应模型的双变量线性回归，评估随访时未矫正视力(UCVA)与每年外科医生手术量和其他病例及人口统计学因素之间的关系。双变量回归中 P 值小于 0.20 的因素纳入具有随机效应模型的多变量线性回归。
白内障手术后的术后 UCVA。
在 91084 例手术中，本研究纳入了 35880 只眼。这些病例由 69 名外科医生完成，在研究期间，他们的年手术量从 76 例到 2900 例不等。每年外科医生手术量的增加与 PECE 中 UCVA 的显著但临床意义不大的改善独立相关，但在 SICS 中则不然。当比较年手术量为 350 例或更少的外科医生时，这种相关性最为明显；年手术量超过 350 例的外科医生之间的结果相似。同样，每年手术量的增加与 PECE 和 SICS 中并发症发生率的显著降低相关。在 PECE 和 SICS 中，年轻患者年龄与视力结果的改善和并发症发生率的降低独立相关。外科医生经验的增加与 PECE 中并发症发生率的降低相关，但与 SICS 无关，与视力结果也没有显著关联。
高容量白内障外科医生在 PECE 中显示出更好的视力结果，在 PECE 和 SICS 中降低了并发症发生率。这些发现进一步支持高输出眼科诊所的益处，即单个外科医生每年进行大量白内障手术，特别是在白内障未治疗人数众多且白内障患者与外科医生比例较高的发展中国家。
