Details

Autor(en) / Beteiligte

• Keane, Miriam C
• Mills, Richard AD
• Coster, Douglas J
• Williams, Keryn A

Titel

Is there evidence for a surgeon learning curve for endothelial keratoplasty in Australia?

Ist Teil von

• Clinical & experimental ophthalmology, 2017-08, Vol.45 (6), p.575-583

Ort / Verlag

Australia: Wiley Subscription Services, Inc

Erscheinungsjahr

2017

Quelle

Wiley-Blackwell Journals

Beschreibungen/Notizen

• Importance Expected outcomes from endokeratoplasty may vary with surgeon experience. Background It was explored whether a surgeon learning curve exists for Descemet stripping endothelial keratoplasties (manual or automated) performed in Australia. Design This is a prospective cohort study, with various clinical settings. Participants There were 2139 recipients of 2615 endothelial grafts, registered by 85 surgeons between January 2006 and December 2013. Methods Kaplan–Meier survival analyses and Cox proportional hazards regression were used to examine longitudinal graft survival. Manual and automated Descemet stripping endothelial keratoplasties were analysed together. Pearson chi‐squared analyses were performed to examine differences amongst groups. Continuity correction was used for 2 × 2 tests, and statistical significance was set at P < 0.05 (two‐sided). Main outcome measure The main parameter measured was endothelial graft survival. Results Survival of the first 56 registered grafts was significantly poorer than survival of subsequent grafts (χ2 = 8.83, df = 1, P = 0.003), when data were combined for all surgeons. Surgeon workload influenced graft survival significantly (P < 0.001). This variable was retained in multivariate analysis designed to investigate independent factors influencing graft survival. Primary non‐functioning grafts were significantly less likely to be reported for endokeratoplasties performed by surgeons with more than 56 registered grafts, compared with those registering 56 or fewer grafts (4.3% vs. 8.5%; χ2 = 18.38, df = 1, P < 0.001). Conclusions and Relevance Our findings suggest that for less experienced or low‐volume surgeons, longitudinal graft survival improved once 56 or more endokeratoplasties had been performed, indicative of a learning curve. The learning curve was less apparent for surgeons with 57 or more Descemet stripping endothelial keratoplasties and/or Descemet stripping automated endothelial keratoplasties registered during the 8‐year study period. Different learning curves may be anticipated for these two groups of surgeons.