Background/aims To assess surgical patterns in ophthalmology by subspecialty in the USA. Methods Ophthalmic surgeons were categorised as comprehensive/subspecialist based on billed procedures in the 2017–2018 Medicare Provider Utilization and Payment Data. Poisson regression models assessed factors associated with physicians performing surgeries in the core domain (eg, cataract extractions) and subspecialty domain. Models were adjusted for provider gender, time since graduation, geographical region, practice setting and hospital affiliation. Results There were 10 346 ophthalmic surgeons, 74.7% comprehensive and 25.3% subspecialists. Cataract extractions were performed by 6.0%, 9.9%, 21.0%, 88.1% and 95.3% of specialists in surgical retina, neuro-ophthalmology/paediatrics, oculoplastics, glaucoma and cornea, respectively. Retina specialists were more likely to perform cataract surgery if they were 20–30 or>30 years in practice (relative risk: 2.20 (95% CI: 1.17 to 4.12) and 3.74 (95% CI: 1.80 to 7.76), respectively) or in a non-metropolitan setting (3.78 (95% CI: 1.71 to 8.38)). Among oculoplastics specialists, male surgeons (2.71 (95% CI: 1.36 to 5.42)), those in practice 10–20 years or 20–30 years (1.93 (95% CI: 1.15 to 3.26) and 1.91 (95% CI: 1.11 to 3.27), respectively) and in non-metropolitan settings (3.07 (95% CI: 1.88 to 5.02)) were more likely to perform cataract surgery. Only 26 of the 2620 subspecialists performed surgeries in two or more subspecialty domains. Conclusions There is a trend towards surgical subspecialisation in ophthalmology in the USA whereby some surgeons focus their surgical practice on subspecialty procedures and rarely perform surgeries in the core domain. Data are available upon reasonable request. See above.

中文翻译：

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美国眼科外科亚专科的全国趋势


背景/目的 评估美国各亚专科的眼科手术模式。方法 根据 2017-2018 年医疗保险提供者利用和支付数据中的计费程序，将眼外科医生分为综合/亚专科。泊松回归模型评估了与医生在核心领域（例如白内障摘除术）和亚专业领域进行手术相关的因素。模型根据提供者性别、毕业时间、地理区域、实践环境和医院隶属关系进行了调整。结果 共有眼科医生10 346人，其中专科医生占74.7%，亚专科医生占25.3%。视网膜外科、神经眼科/儿科、眼部整形、青光眼和角膜方面的专家分别有 6.0%、9.9%、21.0%、88.1% 和 95.3% 的专家进行了白内障摘除术。视网膜专家如果执业时间为 20-30 或>30 年，则更有可能进行白内障手术（相对风险：分别为 2.20（95% CI：1.17 至 4.12）和 3.74（95% CI：1.80 至 7.76））或在非大都市环境中（3.78（95% CI：1.71 至 8.38））。在眼整形专家中，男性外科医生（2.71（95% CI：1.36至5.42））、执业10-20年或20-​​30年的外科医生（1.93（95% CI：1.15至3.26）和1.91（95% CI：1.11）分别为 3.27）和非大城市地区（3.07（95% CI：1.88 至 5.02））更有可能进行白内障手术。 2620 名专科医生中只有 26 人在两个或更多专科领域进行了手术。结论 美国眼科存在外科亚专科化的趋势，一些外科医生将其手术实践集中在亚专科手术上，很少在核心领域进行手术。数据可根据合理要求提供。见上文。