Graphical comparison of surgeon outcomes for the audit of a national corneal transplant registry (OTAG study 32)
© 2022. The Author(s), under exclusive licence to The Royal College of Ophthalmologists..
PURPOSE: To compare Kaplan-Meier survival curves and funnel plots for the audit of surgeon-specific corneal transplantation outcomes.
METHODS: We obtained data on all patients with Fuchs endothelial dystrophy (FED) receiving a first corneal transplant in one eye between January 2012 and December 2017. We produced 2-year Kaplan-Meier graft survival curves to compare a simulated individual surgeon's graft survival rate to national pooled data. We used funnel plots to compare all surgeon outcomes to the national graft survival rate with superimposed 95 and 99.8% confidence limits. We defined an outlier as a surgeon who performed ≥10 transplants and had graft survival below the 99.8% national lower limit. To assess the effect of the surgeon case mix, we also compared unadjusted and risk-adjusted graft survival rates.
RESULTS: There were 3616 first corneal transplants for FED patients with complete data, performed or overseen by 196 surgeons. The 2-year national graft survival rate was 88%. The median change from the unadjusted to the risk-adjusted graft survival rate for individual surgeons was 0% (IQR: 0%- -2%). Of the 108 surgeons who had performed ≥10 transplants, we identified two outliers based on the unadjusted graft survival funnel plot, compared to four outliers based on the risk-adjusted graft survival funnel plot.
CONCLUSION: Funnel plots provide a visually accessible method for comparing individual graft survival rates to the national rate. Risk-adjustment accounts for clinical factors, and this has advantages for audit and clinical governance.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:37 |
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| Enthalten in: |
Eye (London, England) - 37(2023), 6 vom: 15. Apr., Seite 1236-1241 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Hopkinson, Cathy [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 17.04.2023 Date Revised 02.04.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1038/s41433-022-02100-8 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM341128376 |
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| 100 | 1 | |a Hopkinson, Cathy |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Graphical comparison of surgeon outcomes for the audit of a national corneal transplant registry (OTAG study 32) |
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| 500 | |a Date Revised 02.04.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2022. The Author(s), under exclusive licence to The Royal College of Ophthalmologists. | ||
| 520 | |a PURPOSE: To compare Kaplan-Meier survival curves and funnel plots for the audit of surgeon-specific corneal transplantation outcomes | ||
| 520 | |a METHODS: We obtained data on all patients with Fuchs endothelial dystrophy (FED) receiving a first corneal transplant in one eye between January 2012 and December 2017. We produced 2-year Kaplan-Meier graft survival curves to compare a simulated individual surgeon's graft survival rate to national pooled data. We used funnel plots to compare all surgeon outcomes to the national graft survival rate with superimposed 95 and 99.8% confidence limits. We defined an outlier as a surgeon who performed ≥10 transplants and had graft survival below the 99.8% national lower limit. To assess the effect of the surgeon case mix, we also compared unadjusted and risk-adjusted graft survival rates | ||
| 520 | |a RESULTS: There were 3616 first corneal transplants for FED patients with complete data, performed or overseen by 196 surgeons. The 2-year national graft survival rate was 88%. The median change from the unadjusted to the risk-adjusted graft survival rate for individual surgeons was 0% (IQR: 0%- -2%). Of the 108 surgeons who had performed ≥10 transplants, we identified two outliers based on the unadjusted graft survival funnel plot, compared to four outliers based on the risk-adjusted graft survival funnel plot | ||
| 520 | |a CONCLUSION: Funnel plots provide a visually accessible method for comparing individual graft survival rates to the national rate. Risk-adjustment accounts for clinical factors, and this has advantages for audit and clinical governance | ||
| 650 | 4 | |a Journal Article | |
| 700 | 1 | |a Curnow, Elinor |e verfasserin |4 aut | |
| 700 | 1 | |a Larkin, Daniel F P |e verfasserin |4 aut | |
| 700 | 1 | |a Prydal, Jeremy |e verfasserin |4 aut | |
| 700 | 1 | |a Tuft, Stephen |e verfasserin |4 aut | |
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