Errors in strabismus surgery

To determine the prevalence of and contributing factors for errors in strabismus surgery.

Five hundred seventeen of 1103 strabismus surgeons (46.87%) completed a survey administered during the 2011 American Association for Pediatric Ophthalmology and Strabismus national meeting or e-mailed to members of the association.

One hundred seventy-three strabismus surgeons (33.5%) self-reported having operated on the wrong eye or muscle or performed the wrong procedure at least once. The mean error rate was 1 in 2506 (95% CI, 2128-2941) operations. Surgeons who performed fewer than the median 1500 procedures had an error rate 5.9 (95% CI, 4.1-8.2) times higher than surgeons who performed more than the median (P < .001). The most common factors contributing to errors were confusion between the type of deviation (esotropia/exotropia) and/or the surgical procedure (recession/resection) (34 of 114 responses [29.8%]), globe torsion (20 [17.5%]) leading primarily to inadvertent operation on the inferior rectus rather than the intended medial rectus muscle, and inattention and/or distraction (19 [16.7%]). Running more than 1 operating room (P = .02) and failing to mark eye muscles preoperatively (P = .03) were associated with an increased likelihood of error.

Self-reported error in strabismus surgery is a complication approximately as common as periorbital cellulitis. Reducing error in strabismus surgery might entail confirming that the deviation matches the surgical plan preoperatively, more elaborate site marking, and involving an assistant in a preoperative verification of the specific eye muscles and surgical procedure.