PURPOSE The primary objective was to assess associations between annual surgeon case volume and visual acuity outcomes after cataract surgery. Secondary objectives included (1) assessing associations between other case and patient characteristics and visual acuity outcomes and (2) assessing associations between annual surgeon case volume and complication rates. DESIGN Database study. PARTICIPANTS All adult eyes that underwent small-incision cataract surgery (SICS) or phacoemulsification cataract extraction (PECE) with intraocular lens placement at the Aravind Eye Hospital, Madurai, India, during 2015. METHODS Descriptive statistics were used to characterize the study population. Uncorrected visual acuity (UCVA) at follow-up was assessed relative to annual surgeon case volume and other case and demographic factors using bivariate linear regression with random effects modeling. Factors with P values of less than 0.20 on bivariate regression were included in multivariate linear regression with random effects modeling. MAIN OUTCOME MEASURES Postoperative UCVA after cataract surgery. RESULTS Of 91 084 surgeries, 35 880 eyes were included in this study. Cases were performed by 69 surgeons, who varied in annual case volume from 76 to 2900 cases during the study period. Increasing annual surgeon case volume was independently associated with a statistically significant but clinically modest improvement in UCVA in PECE but not in SICS. This association was most pronounced when comparing surgeons with case volumes of 350 PECE/year or fewer; surgeons with more than 350 PECE/year had similar results to one another. Similarly, increased annual case volume was associated with significantly lower complication rates, both in PECE and SICS. Younger patient age was independently associated with improved visual acuity outcomes and lower complication rates in both PECE and SICS. Greater surgeon experience was associated with lower complication rates in PECE, but not SICS, and there was no significant association with visual acuity outcomes. CONCLUSIONS High-volume cataract surgeons showed improved visual acuity outcomes in PECE and lower complication rates in PECE and SICS. These findings further support the benefit of high-output ophthalmology clinics wherein individual surgeons perform a high number of cataract extractions annually, particularly in developing nations where there is a large backlog of untreated cataracts and the cataract patient-to-surgeon ratio is high.

中文翻译：

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白内障手术后的视力结果：大批量与小批量手术。

目的主要目的是评估白内障手术后每年的外科医生病例数量与视力结果之间的关联。次要目标包括（1）评估其他病例与患者特征和视敏度结果之间的关联，以及（2）评估外科医生年度病例量与并发症发生率之间的关联。设计数据库研究。研究对象2015年期间在印度马杜赖的Aravind眼科医院接受小切口白内障手术（SICS）或超声乳化白内障摘除术（PECE）并人工晶状体植入的所有成年眼睛。方法采用描述性统计数据来表征研究人群。使用双变量线性回归和随机效应模型对随访时未矫正的视敏度（UCVA）进行了相对于年度外科医生病例数量以及其他病例和人口统计学因素的评估。双变量回归中P值小于0.20的因素包括在具有随机效应模型的多元线性回归中。主要观察指标：白内障手术后术后UCVA。结果在91 084手术中，本研究包括35 880眼。病例由69名外科医生进行，在研究期间，他们的年病例量从76例增加到2900例。年度外科医生病例数的增加与PECE的UCVA有统计学意义但临床上适度的改善有独立的联系，但SICS却没有。当将外科医生的病例数量为350 PECE /年或更少的外科医生进行比较时，这种关联最为明显。每年有超过350次PECE的外科医生，彼此的结果相似。同样，在PECE和SICS中，每年病例数的增加与并发症发生率显着降低有关。在PECE和SICS中，患者年龄的降低与视敏度的提高和并发症发生率的降低独立相关。在PECE中，更多的外科医生经验与较低的并发症发生率相关，而SICS则与较低的并发症发生率相关，并且与视敏度结果没有显着相关性。结论大容量白内障外科医生显示PECE的视敏度得到改善，而PECE和SICS的并发症发生率更低。