NEW YORK (Reuters Health) – Postcataract surgery endophthalmitis rates in the United States declined slightly between 2003 and 2004, but there is still room for improvement, according to a report in the January 31st online Ophthalmology.
“Endophthalmitis rates in the US in 2003-2004 were lower than in previous years; however, they were still higher than rates reported in other countries,” Dr. Emily W. Gower from Wake Forest University School of Medicine, Winston-Salem, North Carolina told Reuters Health in an email. “Our study found a link between reduced surgical volume and years of experience and increased endophthalmitis risk.”
Dr. Gower and colleagues used administrative data from 100% of the cataract surgeries billed to Medicare in 2003 and 2004 to examine recent rates of endophthalmitis.
Among 3,280,966 cataract surgeries within the 2 years, 4006 patients developed endophthalmitis within 42 days of cataract surgery.
The national endophthalmitis rate was 1.33 per 1000 surgeries in 2003 and 1.11 per 1000 surgeries in 2004, a 13% decline after adjusting for other factors.
These rates are substantially higher than the rate reported in Sweden for the same time period (0.48 per 1000 surgeries), the researchers note, but they are similar to the rate reported for the same period in Ontario, Canada (1.4 per 1000 surgeries).
Endophthalmitis rates differed significantly across states, with the highest rates in Mississippi and Rhode Island and the lowest rates in Idaho, South Dakota, and New Hampshire.
Endophthalmitis rates were 4-fold higher among surgeries performed by surgeons completing 50 or fewer surgeries per year compared with surgeries performed by surgeons with annual volume above 1000 surgeries. This association persisted in multivariate models.
Endophthalmitis rates were 23% higher after surgeries performed in hospital outpatient centers than after surgeries performed in ambulatory surgery centers, but this difference disappeared after adjusting for age, gender, race, year of surgery, and surgeon volume and experience.
Endophthalmitis risk increased with increasing age, and rates were higher for males than for females and for black and Native Americans than for whites.
“The large number of cataract surgeries performed annually makes endophthalmitis an important public health problem,” Dr. Gower said. “Prospective research into factors that can reduce endophthalmitis risk are needed. One key area of research is the benefit of intracameral antibiotic injections.”
“We are finalizing data analyses from a nationally representative case-control study that will allow us to look at disparities in infection rates across types of surgical practices,” Dr. Gower said. “We are looking at several factors including: anti-infective measures, wound construction and closure, additional procedures performed.”
Source:
Ophthalmology. January 31, 2012.
