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When should cataract surgeons seek assistance from experienced colleagues?

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Abstract

Purpose

To assess which cases should be assorted exclusively to high-volume surgeons and identify when should a cataract surgeon seek assistance from a senior colleague.

Methods

The medical records of 2853 patients with age-related cataract were reviewed. Preoperative risk factors were documented for each case, and they were divided into surgeons who had more (> 400 surgeries/year) or less experience (< 400 surgeries/year). Ophthalmology residents were excluded from this review. The cases that involved posterior capsule rupture, dropped nucleus, zonular dehiscence and anterior capsular tear with or without vitreous loss were defined as “complicated”.

Results

From the 3247 cataract extraction surgeries that were reviewed, we were unable to identify any statistically significant difference in the complication rates between the two surgeon groups. In the stepwise regression analysis, both groups supported advanced age (> 85) and mature cataracts with up to fourfold odds ratios (OR). Low-volume surgeons had a fivefold OR in the presence of phacodonesis and a fourfold OR in the case of posterior polar cataract. Finally, the low- and high-volume groups had their highest complication rates in the cumulative four and five risk factors, respectively.

Conclusion

In the presence of advanced age, mature cataracts, phacodonesis and posterior polar cataract, the complication rates appear to be higher for the less experienced surgeons. Meticulous preoperative assessment with detailed documentation of each patient’s risk factors can result in fewer complications. The medical complexity of each case can be used as indicator of whether a more experienced surgeon should perform the surgery or not.

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Funding

The authors declare that no funds, grants or other support was received during the preparation of this manuscript.

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Authors and Affiliations

  1. 2nd Department of Ophthalmology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Eirini Oustoglou, Argyrios Tzamalis, Lamprini Banou, Chrysanthos D. Christou, Ioannis Tsinopoulos, Maria Samouilidou, Asimina Mataftsi & Nikolaos Ziakas

Authors
  1. Eirini Oustoglou
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  2. Argyrios Tzamalis
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  3. Lamprini Banou
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  4. Chrysanthos D. Christou
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  5. Ioannis Tsinopoulos
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  6. Maria Samouilidou
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  7. Asimina Mataftsi
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  8. Nikolaos Ziakas
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by OE, LB, CDC and MS. The first draft of the manuscript was written by OE, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Eirini Oustoglou.

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Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Aristotle University of Thessaloniki and the Institutional Review Board of Papageorgiou General Hospital.

Competing interests

The authors have no relevant financial or non-financial interests to disclose.

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Oustoglou, E., Tzamalis, A., Banou, L. et al. When should cataract surgeons seek assistance from experienced colleagues?. Int Ophthalmol 43, 387–395 (2023). https://doi.org/10.1007/s10792-022-02434-y

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  • DOI: https://doi.org/10.1007/s10792-022-02434-y

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