Time Of Day Is Not A Risk Factor - A Temporal Analysis Of Cataract Surgery Complications

Posterior capsule rupture rate is a known complication of cataract surgery and numerous studies have identified risk factors for its’ incidence including experience of the surgeon and case complexity.  Studies have shown in other surgical specialties that surgeon fatigue is associated with an increase in complications.  However, only one small study of 1424 patients has specifically investigated cataract surgery and concluded that surgical case order might not affect complication rates of cataract surgery. 

The aim of this study was to determine, using big data, whether operative complications were more likely to occur towards the end of a high volume cataract list.

60 cataract surgery centres in the United Kingdom between 01/01/2015 and 01/01/2025

Analysis of the electronic medical records (Medisight) of all patients who had a posterior capsule rupture (with or without vitreous loss) between January 2015 and January 2025 at a group of 60 cataract surgery centres.  Position on the full day list, experience of the surgeon and complexity of the cases was included as part of the analysis.

In the10 year period, 750,000 cataract operations were performed of which 4,388 (0.59%) had a posterior capsule rupture.  The majority of PCRs (57.91%) occurred in the morning of a full day list with (16.87%) occurring at 11am.  However, this was not statistically significant.  More experienced surgeons were less likely to have a complication and case complexity was associated with an increased complication rate.         

Whilst other surgical specialities have demonstrated that surgeon fatigue is associated with an increased rate of complications, this big data study has identified that this is not the case in cataract surgery.  When performing a full day of cataract surgery, the risk of complication was greater in the morning than the end of the list when the surgeon is more likely to be fatigued.  Other risk factors, including cases complexity and experience of the surgeon, are more significant than the timing on the list.  Surgeons and service commissioners should be reassured that high volume lists are safe and that higher volume cataract surgery is associated with a lower complication rate.