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

Abstract

AbstractPurposeThe 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.MethodsFee-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.ResultsAmong 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).ConclusionsPatient-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.