Non-refractive corneal surgery and its surgical workforce in France: a nationwide analysis of the French National Health Data System (SNDS)

Purpose To provide a nationwide description of non-refractive corneal surgical procedures and of the surgeons performing them, using data from the French National Health Data System (SNDS). Methods We conducted a nationwide observational study using the French National Health Data System (SNDS). All patients aged 20 years or older who underwent non-refractive corneal surgery in metropolitan France in 2016 were identified. We described the number and type of procedures and the national crude and age-standardized incidence, and, for surgeons performing at least ten highly specialized procedures during the year, their number, mean age and the proportion aged over 55 years, overall and by operating center. Results A total of 19,742 corneal surgical procedures were performed in patients aged 20 years and older in 2016. Among these, 5601 corresponded to highly specialized procedures, including corneal transplantation and other advanced corneal surgeries. Most highly specialized procedures were performed in public hospitals, while a smaller share was carried out by private practitioners with regular surgical activity. Overall, 132 surgeons were identified as performing at least 10 highly specialized procedures during the year. Among them, 13.6% were aged 55 years or older. Conclusion This nationwide study provides a detailed description of non-refractive corneal surgical activity in France and of the workforce performing it, showing that highly specialized activity is concentrated in a limited number of high-volume centers. Monitoring these indicators from routine national data could help inform the future organization and training of the corneal surgical workforce.