surgical safety culture and postoperative endophthalmitis: A real-world study

Background Postoperative endophthalmitis (POE) is a severe complication of intraocular surgery. This study aimed to evaluate the impact of a surgical safety intervention on the POE rate. Methods In late 2019, a multifaceted surgical safety intervention was established and implemented at the study hospital, targeting all staff involved in ophthalmic surgery. The intervention comprised five components: surgical safety visual cues, periodic training and educational meetings, regulation of surgical instruments, surface microbial sampling, and video-based performance review. We included all patients who underwent inpatient ophthalmic surgery between January 1, 2017 and December 31, 2023, and compared the POE incidence before (2017–2019) and after (2020–2023) implementation. Results A total of 191,657 patients were included. The POE incidence decreased by 64.4% after intervention (pre-intervention: 0.038% [27/71,978], 95% confidence interval [CI]: 0.025–0.055%; post-intervention: 0.013% [16/119,679], 95% CI: 0.008–0.022%; P < 0.001). Poisson regression confirmed a significant downward trend in annual POE incidence with continued implementation (incidence rate ratio [IRR] = 0.619, 95% CI: 0.523–0.733, P < 0.001). The highest POE incidence across the study period occurred in patients undergoing cataract and crystalline lens surgery (0.055% [15/27,098], 95% CI: 0.031–0.091%), and this subspecialty showed a more than six-fold reduction after intervention (pre: 0.132% [11/8,344], 95% CI: 0.066–0.236%; post: 0.021% [4/18,754], 95% CI: 0.006–0.055%; P < 0.001). Conclusions Promoting surgical safety through a multifaceted approach is effective and sustainable in reducing the POE rate. This study offers a highly accessible intervention framework to improve the safety of ophthalmic surgeries.