To check Kaplan–Meier survival curves and funnel plots for the audit of surgeon-specific corneal transplantation outcomes.
We obtained knowledge on all sufferers with Fuchs endothelial dystrophy (FED) receiving a primary corneal transplant in a single eye between January 2012 and December 2017. We produced 2-year Kaplan–Meier graft survival curves to match a simulated particular person surgeon’s graft survival charge to nationwide pooled knowledge. We used funnel plots to match all surgeon outcomes to the nationwide graft survival charge with superimposed 95 and 99.8% confidence limits. We outlined an outlier as a surgeon who carried out ≥10 transplants and had graft survival under the 99.8% nationwide decrease restrict. To evaluate the impact of the surgeon case combine, we additionally in contrast unadjusted and risk-adjusted graft survival charges.
There have been 3616 first corneal transplants for FED sufferers with full knowledge, carried out or overseen by 196 surgeons. The two-year nationwide graft survival charge was 88%. The median change from the unadjusted to the risk-adjusted graft survival charge for particular person surgeons was 0% (IQR: 0%– −2%). Of the 108 surgeons who had carried out ≥10 transplants, we recognized two outliers primarily based on the unadjusted graft survival funnel plot, in comparison with 4 outliers primarily based on the risk-adjusted graft survival funnel plot.
Funnel plots present a visually accessible methodology for evaluating particular person graft survival charges to the nationwide charge. Danger-adjustment accounts for medical components, and this has benefits for audit and medical governance.