Outsourced cataract surgery and postoperative endophthalmitis

To compare the risk of postoperative endophthalmitis (PE) after cataract surgery at eye departments in public hospitals and private hospitals/eye clinics and to evaluate if the Danish National Patient Registry (NPR) is a reliable database to monitor the PE risk.

Postoperative endophthalmitis cases were retrospectively identified via the NPR and chart review in order to confirm PE cases that had cataract surgery in the calendar period 2002-2010.

We identified 39 cases of PE after 107 701 registered public cataract operations; PE risk = 0.36 [corrected] per 1000 operations and 27 cases of PE after 36 760 registered private operations; PE risk = 0.73 [corrected] per 1000 operations. There was homogeneity in the PE risk among the eye departments in public hospitals (p = 0.6), but heterogeneity in the PE risk among the private hospitals/eye clinics (p = 0.0001). Six private hospitals/eye clinics had a statistically significantly higher PE risk compared with the eye departments in public hospitals. In all, 98% of public cataract surgery was registered in the NPR compared with 38% of private cataract surgery. The private hospitals/eye clinics with the highest PE risk after registered cataract surgery had many cases of PE where the causative cataract operation was not registered with the NPR.

A few private hospitals/eye clinics had a statistically significantly higher PE risk than the PE risk at the eye departments in public hospitals. The lack of registration with the NPR by the private hospitals/eye clinics suggests that better monitoring of cataract surgery is needed in Denmark to reduce risk and to improve quality.