Variation between surgeons in reoperation rates following vertical strabismus surgery: Associations with patient and surgeon characteristics and adjustable sutures

Purpose: To quantify inter-surgeon variation in vertical strabismus surgery reoperation rates, and to explore associations of reoperation rate with practice type and volume, surgical techniques, and patient characteristics. Methods: Fee-for-service payments to providers in a national database for Medicare beneficiaries having vertical strabismus surgery between 2012 and 2020 were retrospectively analyzed to identify reoperations in the same calendar year. Predictors of the rate of reoperation for each surgeon were determined by multivariable linear regression. Results: Among 73 surgeons, the reoperation rate for 1-vertical muscle surgery varied from 0.0% to 40.7%. Due to the presence of high-volume surgeons with high reoperation rates, just 11% of surgeons contributed over half of the reoperation events for 1-vertical muscle surgery. 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. Patient poverty was independently associated with a lower surgeon reoperation rate (p = 0.03). Still, the multivariable model could explain only 14.2% of the variation in surgeon reoperation rate for 1-vertical muscle. 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.