Surgeons' perspectives on intraoperative gray area surgical complications of cataract surgery

Purpose:To explore surgeons' perspectives and practice patterns in gray area surgical complications (GASCs) within cataract surgery.Setting:Tertiary care academic referral center.Design:Retrospective observational cross-sectional study.Methods:An anonymous, online survey consisting of 11 potential intraoperative GASC scenarios was developed and distributed to practicing and resident ophthalmologists in the U.S. Demographic data such as gender, experience, and practice settings were recorded. Using a Likert scale, respondents scaled their perception of likelihood that a GASC could lead to postoperative complications and their obligation toward patient disclosure and documentation in the operative report. Respondents also scaled their likelihood of agreement with a series of statements inserted to assess baseline anxiety levels and inherent perspectives regarding disclosure.Results:389 responses were analyzed. Female surgeons were more likely than male surgeons to disclose GASCs to their patients and experience psychological anxiety regarding patient outcomes. Both early- and late-stage residents were more likely to believe that GASCs could lead to vision-limiting outcomes when compared with attending surgeons. Surgeons at academic centers were more likely than community-based surgeons to disclose GASCs in the operative report and experience psychological anxiety regarding patient outcomes.Conclusions:Significant differences based on gender, practice setting, and level of experience exist in disclosure and documentation of intraoperative GASCs. Additional studies are needed to further explore reasons for these differences, as reporting patterns may affect patient satisfaction, medicolegal risks, and postoperative surgeon-experienced anxiety.