Impact of surgical complexity and surgeon experience on phacoemulsification outcomes: a one-year retrospective study from a Saudi tertiary eye hospital.

Introduction: This study aimed to assess one-year outcomes of phacoemulsification cataract surgery at King Khaled Eye Specialist Hospital (KKESH), a tertiary referral teaching hospital in Saudi Arabia. Evaluated outcomes included intraoperative complications, postoperative visual outcomes, and the association of surgeon experience and surgical complexity with posterior capsule rupture (PCR) and visual outcomes. Methods: A retrospective review included 3,377 eyes that underwent phacoemulsification cataract surgery between January 1 and December 31, 2019. Data were extracted from TrakCare, the hospital's electronic medical record system. Variables included demographics, pre- and postoperative visual acuity, intraoperative complications, combined surgical procedures, and surgeon experience. Statistical analyses were performed using Stata version 16.1. Comparisons between surgeon groups were performed using analysis of variance and chi-square tests. Multivariable logistic regression was used to identify factors associated with PCR, and multivariable linear regression was performed to evaluate predictors of postoperative visual acuity. Statistical significance was defined as P < 0.05. Results: A total of 3,377 phacoemulsification cataract surgeries were included. The mean patient age was 62.7 ± 13.1 years, 50.8% were male, and diabetes was present in 14.0% of patients. The overall posterior capsule rupture (PCR) rate was 2.8%. Although attending surgeons managed patients with poorer preoperative visual acuity and performed a greater proportion of combined procedures, surgeon level was not independently associated with PCR after adjustment for patient and surgical factors. Combined surgery was independently associated with a higher likelihood of PCR (adjusted OR 2.44, 95% CI 1.41-4.25; P = 0.002). Postoperative visual acuity improved significantly overall, while poorer postoperative visual acuity was independently associated with combined surgery, diabetes, and worse preoperative visual acuity, but not with PCR after multivariable adjustment. Conclusion: Phacoemulsification cataract surgery at a tertiary referral eye center achieved low complication rates and favorable visual outcomes, consistent with international benchmarks. After adjustment for baseline characteristics, surgical complexity rather than surgeon experience was independently associated with PCR and postoperative visual outcomes. These findings support structured case allocation in teaching hospitals and provide valuable benchmarks for surgical training and quality improvement.