Table 3 Results from retrospective database analyses (thyroid and cataract surgery)

Country

USA

USA

USA

Sponsor

NA

NA

National Eye Institute: R01EY016769. K.K funded by an Australian National Health and Medical Research Council post-doctoral fellowship. E.W.G. recipient of an Ernest and Elizabeth Althouse Special Scholar’s Award from Research to Prevent Blindness.

Conflict of Interest

One author (Yencha) was involved in all cases either as primary or assistant surgeon

None

None

Study design

Retrospective single centre analysis

Retrospective single centre chart review

Retrospective analysis of Medicare beneficiary claims data

Conducted in

2006–2014

2011–2012

2003–2004

Indication

Benign or malignant thyroid carcinoma

Cataract

Cataract

Intervention

Outpatient thyroid surgery/Thyroidectomy

Cataract Surgery (Phacoemulsification)

Cataract Surgery

Setting

Outpatient and Inpatient^a

Outpatient Surgical Centre

Outpatient surgery centres

Type of volume analysis (surgeon/hospital)

Surgeon & Hospital

Surgeon

Surgeon

Comparator

Inpatient Thyroid surgery/Thyroidectomy

NA

NA

Number of pts, I vs C

160 (109 vs 51)^b

3339

2,285,968^c

Both eyes: 1,005,826 (44%)

One eye: 1,280,14221 (56%)

Number of procedures, I vs C^d

Total: 35 vs 26

Hemi: 62 vs 20

Completion: 11 vs 5

NA

3,280,966^e

Number of surgeons

NA

4

11, 873^f

Number of hospitals

1

1

NA

Surgeon/Surgeon volume categories, n (cases/year)

Unclear^g

Surgeon 4: 411

Surgeon 1: 536

Surgeon 2: 1056

Surgeon 3: 1336

(1): 1–50;

(2): 51–200;

(3): 201–500;

(4): 501–1000;

(5): ≥1001

Hospital volume categories, n (cases/year)

Unclear

NA

NA

Operating time, median in min (range)

NA

NA

NA

Inclusion criteria

Patients in ASA class

1,2,3 and 4

Use of topical anaesthesia and performance of the intervention at an outpatient centre/setting

Patients with max. 2 cataract surgeries per beneficiary during the 2-year study timeframe; Medicare beneficiaries ≥65 years

Exclusion criteria

NA

Patients requiring additional anaesthesia and those who were operated on in a hospital setting

Records were excluded if data indicated the surgery was not performed, the procedure was a return to the operating room for a related procedure or due to data coding issues; surgeries performed in the last 42 days of 2004

ASA class, n, I vs C

1 and 2: 90 vs 39

3 and 4: 19 vs 12

NA

NA

Co-interventions

Intravenous dexamethasone, intravenous antibiotics, anaesthesia at surgeon’s discretion, Prophylactic calcium carbonate and vitamin D (calcitriol) supplementation for pts. undergoing total or completion thyroidectomy

NA

NA

Age, mean, yrs (range) [SD]

41.8 (14–75)/47.8 (19–77)

73 (60–86) [3]

NA (≥65^h)

Sex, female:male, n, I vs C

82:27 vs 25:26

13:10

NA

BMI ± SD

NA

NA

NA

Risk Adjustment

NA

NA

Age (65–74, 75–84, ≥85

Gender, Race, Year,

Ambulatory surgery centre (No, Yes),

Surgeon experience in yrs. (1–10, 11–20, 21–30, ≥30)

Other influencing factors

(Comorbidities etc.), n (%)

NA

Shallow chamber: 8 (35);

Miosis: 7 (30); Restlessness: 6 (26);

Floppy Iris: 6 (26);

Pseudoexfoliation: 5 (22);

Zonular dehiscence: 5 (22);

Small eye: 1 (4)

NA

Patients excluded from the analysis, n (%)

NA

NA

165,452 and 35,068ⁱ

Revision Surgery

NA

23^j of 3339

NA

Re-admission^k, n (%), I vs C

0^l vs NA

NA

NA

Surgical volume,

n (cases/year) – Risk of AE related

to surgery

NA

411–3.75;

536–0.37;

1056–0.28;

1336–0.29

PCR in 23 (0.68) in total

Nr. of TE cases:

1–50: 352;

51–200: 1455;

201–500: 1512;

501–1000: 454;

≥1001: 168

Overall Endoph. Rate/1000 surgeries^m (95% CI):

1–50: 2.57 (2.30–2.83);

51–200: 1.49 (1.42–1.57);

201–500: 1.17 (1.11–1.23);

501–1000: 0.80 (0.73–0.88);

≥1001: 0.62 (0.52–0.71)

Surgical volume,

n (cases/year) – Risk of AE related

to surgery

(continuation)

PCR: Unadjusted RR (95% CI):

1–50: 4.17 (3.47–5.01);

51–200: 2.42 (2.06–2.84);

201–500: 1.89 (1.61–2.22);

501–1000: 1.30 (1.09–1.55);

≥1001: 1.00 (Reference)

Adjusted RR: (95% CI):

1–50: 3.80 (3.13–4.61);

51–200: 2.32 (1.97–2.74);

201–500: 1.84 (1.56–2.17);

501–1000: 1.30 (1.09–1.56);

≥1001: 1.00 (Reference)

SAE

NA

NA

NA

AEs, Volume, n

(%),

19 pts. of 160 pts. (11,90%)ⁿ

Transient hypercalcemia: 5%;

Temporary vocal cord paralysis: 2.5%;

Bilateral vocal cord paralysis: 0.63%

Inadvertent transection of the RLN: 0.63%;

Post-operative seromas requiring aspiration: 1.9%;

Post-operative hematoma requiring aspiration: 1.25%

NA

NA