Graphical comparison of surgeon outcomes for the audit of a national corneal transplant registry (OTAG study 32)
Prydal, Jeremy
Prydal, Jeremy
Abstract
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.
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Date
2022-05-20
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Citation
Hopkinson, C., Curnow, E., Larkin, D. F. P., Prydal, J., & Tuft, S. (2022). Graphical comparison of surgeon outcomes for the audit of a national corneal transplant registry (OTAG study 32). Eye (London, England), 10.1038/s41433-022-02100-8. Advance online publication. https://doi.org/10.1038/s41433-022-02100-8