Abstract
Background
Endophthalmitis remains a serious and potentially blinding complication of cataract surgery with an overall incidence of ∼0.14% or one in 700 operations. Despite this knowledge of overall frequency, healthcare providers find themselves confronted with clusters of cases where the appropriate level of response to the cluster is uncertain.
Aim
To illustrate, by means of Monte–Carlo simulation models, the likelihood of random clustering of cases arising in units within a healthcare setting resembling the NHS and separately within the practices of individual surgeons.
Method
Simulation models were constructed within a programming language in which individual cataract operations were simulated with a one in 700 likelihood of each operation resulting in a ‘case of endophthalmitis’. Random clustering of ‘cases of endophthalmitis’ was observed in the models and ‘outbreaks’ were noted and tracked for various outbreak definitions.
Results
The model outputs are presented graphically as the proportion of ‘simulated units’ affected by an ‘outbreak’ in a year and separately as the proportion of surgeons affected for a range of ‘outbreak definitions’.
Conclusion
These data presentations are easy to use and should facilitate a better understanding of shifts from endemic to epidemic rates of endophthalmitis with appropriate investigation of situations where a remediable common cause may exist.
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References
Peyman GA, Lee PJ, Seal DV . Endophthalmitis: Diagnosis and Treatment, Taylor & Francis Group: London 2004.
Kelly SP, Mathews D, Mathews J, Vail A . Reflective consideration of postoperative endophthalmitis as a quality marker. Eye 2005; advance online publication, 13 July 2005; doi:10.1038/sj.eye.6701996.
Khan RI, Kennedy S, Barry P . Incidence of presumed postoperative endophthalmitis in Dublin for a 5-year period (1997–2001). J Cataract Refract Surg 2005; 31: 1575–1581.
Kamalarajah S, Silvestri G, Sharma N, Khan A, Foot B, Ling R et al. Surveillance of endophthalmitis following cataract surgery in the UK. Eye 2004; 18: 580–587.
Powe NR, Schein OD, Gieser SC, Tielsch JM, Luthra R, Javitt J et al. Synthesis of the literature on visual acuity and complications following cataract extraction with intraocular lens implantation. Cataract Patient Outcome Research Team. Arch Ophthalmol 1994; 112: 239–252.
Taban M, Behrens A, Newcomb RL, Nobe MY, Saedi G, Sweet PM et al. Acute endophthalmitis following cataract surgery: a systematic review of the literature. Arch Ophthalmol 2005; 123: 613–620.
Allardice GM, Wright EM, Peterson M, Miller JM . A statistical approach to an outbreak of endophthalmitis following cataract surgery at a hospital in the West of Scotland. J Hosp Infect 2001; 49: 23–29.
Anderson OA, Lee V, Shafi S, Keegan D, Vafidis G . A model for the management of an atypical endophthalmitis outbreak. Eye 2005; 19: 972–980.
Mandal K, Hildreth A, Farrow M, Allen D . Investigation into postoperative endophthalmitis and lessons learned. J Cataract Refract Surg 2004; 30: 1960–1965.
Ismail NA, Pettitt AN, Webster RA . Online monitoring and retrospective analysis of hospital outcomes based on a scan statistic. Stat Med 2003; 22: 2861–2876.
Beiles CB, Morton AP . Cumulative sum control charts for assessing performance in arterial surgery. ANZ J Surg 2004; 74: 146–151.
Anuradha S, Gandhewar R, Feyi-Waboso A . The use of control charts in monitoring endophthalmitis. Royal College of Ophthalmologists Annual Congress 2004.
Elliott A . Managing an outbreak of postoperative endophthalmitis. Royal College of Ophthalmologists Ophthalmic Services Folder, 2004; http://www.rcophth.ac.uk/docs/college/Endophthalmitis.pdf.
DoH. Hospital activity and episode statistics (2003–2004). http://www.dh.gov.uk/assetRoot/04/09/70/98/04097098.pdf.
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Proprietary interests: None Presented in preliminary form at the Royal College of Ophthalmologists annual congress 2004.
Intended submission for the Association for Research in Vision and Ophthalmology (ARVO) annual meeting 2006
Intended submission for the Royal College of Ophthalmologists annual congress 2006
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Sparrow, J. Monte–Carlo simulation of random clustering of endophthalmitis following cataract surgery. Eye 21, 209–213 (2007). https://doi.org/10.1038/sj.eye.6702170
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DOI: https://doi.org/10.1038/sj.eye.6702170
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