Vitrectomy After Cataract Surgery as a Patient Safety Indicator: A Rapid Review to Support Benchmarking Within the Austrian Inpatient Quality Indicators Framework

Cataract surgery is the most common surgical procedure in high-income countries. It is considered relatively safe and rarely has serious complications. Nevertheless, a quality assessment of the care structures is important, and Inpatient Quality Indicators (IQIs) have already been established at the system level. The Austrian Inpatient Quality Indicator system (A-IQI) uses a nationwide benchmark and annually reports the vitrectomy rate based on all cataract operations as a quality indicator for complications. The primary objective of this study is to validate the Inpatient Quality Indicator for Vitrectomy as a measure of complications during or after cataract surgery, using international comparative values. We conducted a rapid review, searching for studies in MEDLINE and EMBASE from 2012 to 2024. For the data synthesis, we applied a meta-analysis. A total of 3792 studies were screened, of which 25 were eligible. The rapid review showed that the vitrectomy rate following cataract surgery was 1.29% [95% uncertainty interval (UI) 0.78-2.11, I 2 =99.6%] when reported per eye. In contrast, the pooled vitrectomy rate was 0.80% (95% UI: 0.37-1.74, I 2 =99.6%) when reported per patient. This shows that the Austrian benchmark is lower in terms of procedures, but higher in terms of patients. However, due to the A-IQI data using procedures rather than patients as the denominator, a comparison with procedural reporting is recommended. The vitrectomy rate in the A-IQI reporting falls short. The literature shows differences in terms of severity and the number of operations performed per surgeon. Though the A-IQI process and the claims data used show potential, it can be seen that the A-IQI indicator underestimates the rates of complications.