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ROYAL COLLEGE OF OPHTHALMOLOGISTS' NATIONAL DATABASE STUDY OF VITREORETINAL SURGERY

Report 7, Intersurgeon Variations in Primary Rhegmatogenous Retinal Detachment Failure

Sallam, Ahmed B. PhD, FRCOphth*,†; Donachie, Paul H. J. MSc*,‡; Yorston, David FRCOphth‡,§; Steel, David H. W. FRCOphth‡,¶,**; Williamson, Tom H. MD, FRCOphth‡,††; Jackson, Timothy L. PhD, FRCOphth‡‡; Sparrow, John M. DPhil, FRCOphth‡,§§; Johnston, Robert L. FRCOphth*,‡

doi: 10.1097/IAE.0000000000001538
Original Study
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Background/Purpose: To audit variations in primary rhegmatogenous retinal detachment (RD) anatomical failure rates between surgeons, grades of surgeons, and techniques of RD surgery.

Methods: Clinical data of a total of 5,857 eyes undergoing primary RD surgery, from 2000 to 2013 were retrospectively extracted from 15 centers using the same commercially available electronic medical record system, from three vitreoretinal units using an in-house electronic medical record, and from the British and Eire Association of Vitreoretinal Surgeons online registry.

Results: The 5,857 primary RD operations were performed by 117 surgeons: 3,349 (57.2%) by consultants, 520 (8.9%) by independent nonconsultants, and 1,988 (33.9%) by trainees. Surgery comprised pars plana vitrectomy for 4,666 (79.7%) operations, scleral buckle for 815 (13.9%), and pars plana vitrectomy + scleral buckle for 376 (6.4%). The RD reoperation rate at 6 months after primary surgery was 13.9% (725/5,202) and did not differ significantly between consultants and trainees (P = 0.382). For surgeons contributing ≥50 cases, the mean (range) reoperation rates were 13.1% (6.7%–26.8%), 15.1% (11.3%–18.2%), and 15.3% (9.4%–22.1%) for consultants, independent nonconsultants, and trainee surgeons, respectively. The scleral buckle failure rate was not significantly different from pars plana vitrectomy (P = 0.095). Data were not adjusted for case-mix complexity.

Conclusion: The grades of surgeons and the technique of surgery were not associated with a significant difference in primary unadjusted RD failure rates.

A national database study of 5,857 primary retinal detachment operations found no difference in the unadjusted for case-mix complexity failure rate between surgeon grades.

*Ophthalmology Department, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom;

Jones Eye Institute, University of Arkansas for Medical Sciences;

National Ophthalmology Database, The Royal College of Ophthalmologists', London, United Kingdom;

§Ophthalmology Department, Gartnavel General Hospital, Glasgow, United Kingdom;

Sunderland Eye Infirmary, Sunderland, United Kingdom;

**Institute of Genetic Medicine, University of Newcastle Upon Tyne, Newcastle, United Kingdom;

††Ophthalmology Department, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom;

‡‡Ophthalmology Department, King's College London, London, United Kingdom; and

§§Bristol Eye Hospital, Bristol, United Kingdom.

Reprint requests: Ahmed A. Sallam, PhD, FRCOphth, Jones Eye Institute, University of Arkansas for Medical Sciences, 4301 W Markham Street #523 Little Rock, AR, 72205; e-mail: ahmedsallam11@yahoo.com

R. L. Johnston is the Medical Director of Medisoft Limited, which developed the commercially available electronic medical record from which anonymized vitreoretinal data were extracted from 15 sites. T. H. Williamson developed the noncommercial VITREOR EMR database from which data were extracted from three sites to the National Ophthalmology Database for this study. The remaining authors have no financial/conflicting interests to disclose.

© 2018 by Ophthalmic Communications Society, Inc.