Importance:Evidence suggests that the quality of some aspects of care provided by physicians may decrease during their late career stage. However, to our knowledge, data regarding the association of advancing surgeon career phase with cataract surgical outcomes have been lacking. Objective:To investigate whether an increase in cataract surgical adverse events occurs during later surgeon career stages. Design, Setting, and Participants:This population-based study of 499 650 cataract operations performed in Ontario, Canada, between January 1, 2009, and December 31, 2013, investigated the association between late surgeon career stage and the risk of surgical adverse events. Linked health care databases were used to study cataract surgical complications while controlling for patient-, surgeon-, and institution-level covariates. All ophthalmologists who performed cataract surgery in Ontario within the study period were included in the analysis. Exposures:Isolated cataract surgery performed by surgeons at early, mid, and late career stages. Main Outcomes and Measures:Four serious adverse events were evaluated: dropped lens fragments, posterior capsule rupture, suspected endophthalmitis, and retinal detachment. Results:Of 416 502 participants, 244 670 (58.7%) were women, 90 429 (21.7%) were age 66 to 70 years, 111 530 (26.8%) were age 71 to 75 years, 90 809 (21.8%) were age 76 to 80 years, and 123 734 (29.7%) were 81 years or older. Late-career surgeons performed 143 108 of 499 650 cataract operations (28.6%) during the study period. Late surgeon career stage was not associated with an increased overall risk of surgical adverse events (odds ratio [OR] vs midcareer, 1.06; 95% CI, 0.85-1.32). In a sensitivity analysis with surgeon volume removed from the model, late career stage was still not associated with overall adverse surgical events (OR, 1.10; 95% CI, 0.88-1.38). Among individual complications, late surgeon career stage was associated with an increased risk of dropped lens fragment (OR, 2.30; 95% CI, 1.50-3.54) and suspected endophthalmitis (OR, 1.41; 95% CI, 1.01-1.98). These corresponded with small absolute risk differences of 0.11% (95% CI, 0.085%-0.130%) and 0.045% (95% CI, 0.028%-0.063%) for dropped lens fragment and suspected endophthalmitis, respectively. Conclusions and Relevance:These findings suggest that later-career surgeons are performing a substantial proportion of cataract operations with overall low surgical adverse event rates. Future studies might extend evaluations to the frequency of secondary surgical interventions as additional measures of surgical care quality.

译文

重要性:证据表明,医生在职业生涯后期某些方面的护理质量可能会下降。然而,据我们所知,缺乏有关推进外科医生职业阶段与白内障手术结局的关联的数据。
目的:研究在外科医生职业生涯后期是否发生白内障手术不良事件的增加。
设计,地点和参与者:这项基于人群的研究于2009年1月1日至2013年12月31日在加拿大安大略省进行,涉及499650例白内障手术,研究了外科医生职业生涯后期与手术不良事件风险之间的关系。 。链接的医疗保健数据库用于研究白内障手术并发症,同时控制患者,外科医生和机构级别的协变量。分析期间包括了在研究期间在安大略省进行过白内障手术的所有眼科医生。
暴露:在职业早期,中期和晚期,由外科医生进行的孤立白内障手术。
主要结果和措施:评估了四个严重不良事件:晶状体脱落,后囊破裂,可疑眼内炎和视网膜脱离。
结果:416502名参与者中,244670名(58.7%)为女性,90429(21.7%)为66至70岁,111530(26.8%)为71至75岁,90809(21.8%)为年龄76至80岁,而123734(29.7%)为81岁或以上。职业后期医生在研究期间进行了499650次白内障手术中的143108次(占28.6%)。外科医生职业生涯后期与手术不良事件的整体风险增加无关(优势比[OR] vs职业中期,1.06; 95%CI,0.85-1.32)。在从模型中删除手术量的敏感性分析中,职业后期仍未与总体不良手术事件相关(OR,1.10; 95%CI,0.88-1.38)。在个体并发症中,外科医生职业生涯后期与增加的晶状体碎片脱落风险(OR,2.30; 95%CI,1.50-3.54)和可疑眼内炎(OR,1.41; 95%CI,1.01-1.98)相关。这些分别对应于掉落的晶状体碎片和疑似眼内炎的绝对风险差异很小,分别为0.11%(95%CI,0.085%-0.130%)和0.045%(95%CI,0.028%-0.063%)。
结论与相关性:这些发现表明,以后职业的白内障手术的比例很高,总体手术不良事件发生率较低。未来的研究可能会将评估扩展到二次手术干预的频率,作为手术护理质量的附加指标。

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