Inter-surgeon variation in reoperation following strabismus surgery among Medicare beneficiaries: Associations with adjustable sutures, patient and surgeon characteristics.

Abstract

Purpose: The objective of this study was to quantify inter-surgeon variation in strabismus surgery reoperation rates in a large national database of provider payments, and to explore associations of reoperation rate with practice type and volume, surgical techniques, and characteristics of the patient population. Methods: Fee-for-service payments to providers for Medicare beneficiaries having strabismus surgery between 2012 and 2020 were retrospectively analyzed to identify reoperations in the same calendar year. The adjustable-suture technique was considered to be available to the patient if the patient's surgeon billed for adjustable sutures. Predictors of the rate of reoperation for each surgeon were determined by multivariable linear regression. Results: Among 141 surgeons, the reoperation rate for 1-horizontal muscle surgery varied between 0.0% and 30.8%. Due to the presence of high-volume surgeons with high reoperation rates, just 11 surgeons contributed half of the reoperation events for 1-horizontal muscle surgery in this national database. Use of adjustable sutures, surgeon gender, and surgical volume were not independently associated with surgeon reoperation rate. Associations of reoperation with patient characteristics, such as age and poverty, were explored. In a multivariable model, surgeons in the South tended to have a higher reoperation rate (p=0.03). Still, the multivariable model could explain only 16.3% of the variation in surgeon reoperation rate for 1-horizontal muscle. For 1-vertical muscle surgery, patient poverty was associated with a lower surgeon reoperation rate (p=0.008). Conclusions: Patient-level analyses which ignore inter-surgeon variation will be dominated by the practices of a small number of high-volume, high-reoperation surgeons. There are order-of-magnitude variations in reoperation rates among strabismus surgeons, the cause of which remains largely unexplained.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This study did not receive any funding.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

This study used data available to the public on Centers for Medicare Services website: Medicare Provider Utilization and Payment Data: Physician and Other Supplier. 2022. Available from: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Physician-and-Other-Supplier.html .

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Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Data Availability

Data are available from the first author.

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