{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,1]],"date-time":"2025-06-01T04:41:15Z","timestamp":1748752875074,"version":"3.40.5"},"reference-count":20,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2024,11,7]],"date-time":"2024-11-07T00:00:00Z","timestamp":1730937600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Purpose<\/jats:title>\n<jats:p>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.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>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.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>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.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>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.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0310371","type":"journal-article","created":{"date-parts":[[2024,11,7]],"date-time":"2024-11-07T18:24:06Z","timestamp":1731003846000},"page":"e0310371","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Variation between surgeons in reoperation rates following vertical strabismus surgery: Associations with patient and surgeon characteristics and adjustable sutures"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0212-136X","authenticated-orcid":true,"given":"Christopher T.","family":"Leffler","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alicia","family":"Woock","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meagan","family":"Shinbashi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melissa","family":"Suggs","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2024,11,7]]},"reference":[{"key":"pone.0310371.ref001","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1097\/00000658-200211000-00008","article-title":"Hospital and surgeon procedure volume as predictors of outcome following rectal cancer resection","volume":"236","author":"D Schrag","year":"2002","journal-title":"Ann 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Johnston","year":"2010","journal-title":"Eye."},{"key":"pone.0310371.ref005","first-page":"1","article-title":"Graphical comparison of surgeon outcomes for the audit of a national corneal transplant registry (OTAG study 32).","volume":"20","author":"C Hopkinson","year":"2022","journal-title":"Eye"},{"key":"pone.0310371.ref006","doi-asserted-by":"crossref","first-page":"6","DOI":"10.5693\/djo.01.2016.02.001","article-title":"Strabismus surgery among medicare beneficiaries: Imputed rates of reoperation in the same calendar year","volume":"22","author":"CT Leffler","year":"2016","journal-title":"Digit J Ophthalmol"},{"issue":"8","key":"pone.0310371.ref007","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.4103\/ijo.IJO_18_18","article-title":"Reoperation following strabismus surgery among Medicare beneficiaries: Associations with geographic region, academic affiliation, surgeon volume, and adjustable suture technique.","volume":"66","author":"MR Christensen","year":"2018","journal-title":"Indian Journal of Ophthalmology."},{"key":"pone.0310371.ref008","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1016\/j.ajo.2015.05.014","article-title":"Strabismus surgery reoperation rates with adjustable and conventional sutures","volume":"160","author":"CT Leffler","year":"2015","journal-title":"Am J Ophthalmol"},{"key":"pone.0310371.ref009","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.ajo.2015.10.022","article-title":"Rates of reoperation and abnormal binocularity following strabismus surgery in children","volume":"162","author":"CT Leffler","year":"2016","journal-title":"Am J Ophthalmol"},{"issue":"10","key":"pone.0310371.ref010","doi-asserted-by":"crossref","first-page":"1646","DOI":"10.1016\/j.ophtha.2018.04.024","article-title":"Strabismus, strabismus surgery, and reoperation rate in the United States: analysis from the IRIS Registry","volume":"125","author":"MX Repka","year":"2018","journal-title":"Ophthalmology"},{"key":"pone.0310371.ref011","article-title":"Adjustable suture technique is associated with fewer strabismus reoperations in the IRIS\u00ae Registry (Intelligent Research in Sight).","author":"I Oke","year":"2022","journal-title":"Ophthalmology"},{"issue":"6","key":"pone.0310371.ref012","doi-asserted-by":"crossref","first-page":"2037","DOI":"10.1007\/s00417-021-05541-1","article-title":"Strabismus outcomes after surgery: the nationwide SOS France study","volume":"260","author":"Q Colas","year":"2022","journal-title":"Graefe\u2019s Archive for Clinical and Experimental Ophthalmology"},{"year":"2022","journal-title":"Medicare Provider Utilization and Payment Data: Physician and Other Supplier.","key":"pone.0310371.ref013"},{"year":"2022","journal-title":"Medicare Physician & Other Practitioners\u2014by Provider","key":"pone.0310371.ref014"},{"year":"2017","journal-title":"Geographic Terms and Concepts-Census Divisions and Census Regions","key":"pone.0310371.ref015"},{"key":"pone.0310371.ref016","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1136\/bjophthalmol-2012-302932","article-title":"Time trends over five decades, and recent geographical variation, in rates of childhood squint surgery in England","volume":"97","author":"MR Chou","year":"2013","journal-title":"Br J Ophthalmol"},{"key":"pone.0310371.ref017","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/j.jaapos.2013.05.005","article-title":"Strabismus among aged medicare beneficiaries: Impact of health status and region.","volume":"17","author":"MX Repka","year":"2013","journal-title":"J AAPOS."},{"issue":"1","key":"pone.0310371.ref018","first-page":"8","article-title":"Variation between surgeons in rate of reoperation after horizontal strabismus surgery among Medicare beneficiaries: associations with patient and surgeon characteristics and adjustable sutures","volume":"68","author":"CT Leffler","year":"2024","journal-title":"Rom J Ophthalmol"},{"issue":"3","key":"pone.0310371.ref019","first-page":"142","article-title":"Factors leading to loss to follow-up after strabismus surgery in children","volume":"25","author":"CM Daly","year":"2021","journal-title":"Journal of American Association for Pediatric Ophthalmology and Strabismus"},{"issue":"3","key":"pone.0310371.ref020","doi-asserted-by":"crossref","first-page":"156","DOI":"10.3928\/01913913-20210824-02","article-title":"Income disparities in outcomes of horizontal strabismus surgery in a pediatric population","volume":"59","author":"AN Zdonczyk","year":"2022","journal-title":"Journal of Pediatric Ophthalmology & Strabismus"}],"container-title":["PLOS 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