The relation of volume with outcome in phacoemulsification surgery.
OBJECTIVE
High case volume has been associated with better health outcomes for a variety of procedures and conditions including coronary angioplasty, carotid endarterectomy, colorectal surgery, and various types of cancer surgery. The association of volume and outcome has important implications for patient safety and healthcare delivery planning. The relation between surgical volume and outcome has not, as far as is known, been looked at for phacoemulsification alone.


METHODS
All cataract surgery performed from 1996 to 2001 by six consultant surgeons was reviewed. Using theatre logbooks and cross checking with the hospital database, the total number of phacoemulsification procedures performed per surgeon per year was calculated. The total number of operations in which it was judged that significant intraoperative complications occurred was also counted.


RESULTS
When the data were pooled for all the surgeons there was evidence that complication rate decreased over time (Spearman's rho = -0.319, p = 0.058). If the data were pooled from all the years and all the surgeons then there was strong evidence of a decrease in complication rate with an increase in the number of cases (Spearman's rho = -0.63, p<0.01).


CONCLUSIONS
This study is the first to describe a possible relation between volume of surgery and the outcome (as measured by complication rates) for phacoemulsification. There are however some caveats in that the issue of case mix was not addressed and that the results are from a single unit and may not necessarily be generalisable
Habib
M
M
Sunderland Eye Infirmary, Sunderland, UK.
Mandal
K
K
Bunce
C V
CV
Fraser
S G
SG
D002983:Clinical Competence; D004739:England; D006801:Humans; D007431:Intraoperative Complications; D018918:Phacoemulsification / Q000009:adverse effects / Q000592:standards / Q000706:statistics & numerical data*; D011364:Professional Practice / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome