Ophthalmology · 2025
Quality Outcomes and Their Association with Physician Age and Experience at a Single Academic Ophthalmology Center (2009-2023).
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Lin George T, Espinosa Daniel J, Powell Corey, Mian Shahzad I, Weizer Jennifer S
Аннотация
PURPOSE: To determine the association between attending surgeon factors (age, gender, and experience [years since completing training]) and ophthalmic surgical outcomes.
DESIGN: Retrospective cohort study.
PARTICIPANTS: All surgeons practicing at University of Michigan Kellogg Eye Center from 2009 to 2023.
METHODS: Attending physician surgical quality outcomes at a single large academic center from 2009 to 2023 were matched to surgeons' public demographics. Poisson models associated unplanned intraoperative anterior vitrectomy (AVx) rate for cataract surgery and unplanned 30-day reoperation rate for all ophthalmic surgeries with surgeon age, gender, case load, experience, and year of case. Analysis of variance models were used to associate surgeon age/experience with subspecialty outcomes.
MAIN OUTCOME MEASURES: AVx rate for cataract surgery, 30-day unplanned reoperation rate for all ophthalmic surgeries, and quality metrics for all subspecialty surgery.
RESULTS: A total of 111 physicians performing 122 082 surgeries including 50 132 cataract surgeries were analyzed. Ophthalmic subspecialty quality outcomes were reported. Mean AVx was 0.91%. The mean reoperation rate was 1.05%. Less than 3 years of experience (+67% [positive association between < 3 years of experience and higher rate of unplanned AVx], P = 0.006, 95% confidence interval [CI], 16 to 140) was associated with higher AVx, whereas increased case load (-30% per 100 cases, P = 0.005, 95% CI, -46 to -10) and more recent year of surgery (-10% [negative association between more recent year of surgery and unplanned AVx], P < 0.001 95% CI -13 to -6) were associated with lower rates of AVx in multivariate analysis. Gender and age more than 60 years were not significantly associated with AVx. Only age 60 to 64 years (-38%, P = 0.018, 95% CI, -58 to -8) and more recent year of surgery (-3% [more recent year of surgery was associated with 3% lower reoperation rate], P = 0.0017, 95% CI, -5 to -1) were associated with a lower reoperation rate in multivariate analysis. Age 65 years or more and 3 years or less since completing training were significantly associated with decreased case load (P < 0.001). Subspecialty surgery and clinical quality metrics were reported, and subspecialty case volume was associated with age and experience.
CONCLUSIONS: Less than 3 years of experience and lower annual case volume were associated with higher AVx rate in cataract surgery. Senior physician age was not significantly associated with increased AVx. Outcomes improved significantly over time.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
DESIGN: Retrospective cohort study.
PARTICIPANTS: All surgeons practicing at University of Michigan Kellogg Eye Center from 2009 to 2023.
METHODS: Attending physician surgical quality outcomes at a single large academic center from 2009 to 2023 were matched to surgeons' public demographics. Poisson models associated unplanned intraoperative anterior vitrectomy (AVx) rate for cataract surgery and unplanned 30-day reoperation rate for all ophthalmic surgeries with surgeon age, gender, case load, experience, and year of case. Analysis of variance models were used to associate surgeon age/experience with subspecialty outcomes.
MAIN OUTCOME MEASURES: AVx rate for cataract surgery, 30-day unplanned reoperation rate for all ophthalmic surgeries, and quality metrics for all subspecialty surgery.
RESULTS: A total of 111 physicians performing 122 082 surgeries including 50 132 cataract surgeries were analyzed. Ophthalmic subspecialty quality outcomes were reported. Mean AVx was 0.91%. The mean reoperation rate was 1.05%. Less than 3 years of experience (+67% [positive association between < 3 years of experience and higher rate of unplanned AVx], P = 0.006, 95% confidence interval [CI], 16 to 140) was associated with higher AVx, whereas increased case load (-30% per 100 cases, P = 0.005, 95% CI, -46 to -10) and more recent year of surgery (-10% [negative association between more recent year of surgery and unplanned AVx], P < 0.001 95% CI -13 to -6) were associated with lower rates of AVx in multivariate analysis. Gender and age more than 60 years were not significantly associated with AVx. Only age 60 to 64 years (-38%, P = 0.018, 95% CI, -58 to -8) and more recent year of surgery (-3% [more recent year of surgery was associated with 3% lower reoperation rate], P = 0.0017, 95% CI, -5 to -1) were associated with a lower reoperation rate in multivariate analysis. Age 65 years or more and 3 years or less since completing training were significantly associated with decreased case load (P < 0.001). Subspecialty surgery and clinical quality metrics were reported, and subspecialty case volume was associated with age and experience.
CONCLUSIONS: Less than 3 years of experience and lower annual case volume were associated with higher AVx rate in cataract surgery. Senior physician age was not significantly associated with increased AVx. Outcomes improved significantly over time.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.