Published online Sep 12, 2026. doi: 10.5318/wjo.122273
Revised: May 20, 2026
Accepted: June 8, 2026
Published online: September 12, 2026
Processing time: 148 Days and 11.8 Hours
Surgical errors remain an ongoing concern in ophthalmology, particularly in high-volume procedures such as cataract surgery, where even low complication rates translate into significant patient impact. Factors such as surgical start time and surgeon fatigue have been proposed as potential contributors to intraoperative complications, though evidence within ophthalmology remains limited and inconsistent. While some studies in other surgical specialties suggest time-of-day effects on outcomes, data specific to ophthalmology are sparse, and the extent to which surgical timing influences performance remains unclear.
To assess whether the timing of surgery influences the rate of surgical errors and complications during cataract operations.
A retrospective cohort study was conducted at a university center in Sherbrooke, Québec, Canada. We included adults who underwent primary cataract surgery from 2006-2023. Electronic medical records were reviewed for baseline demo
A total of 32762 cataract surgeries were included in the analysis, with an overall complication rate of 1.14%. Temporal analysis across the surgical day (7:00 to 15:00) demonstrated no statistically significant variation in complication rates, which ranged from 0.8% to 1.7%. The highest complication rate was observed at 13:00 (1.66%), while the lowest occurred at 15:00 (0.76%); however, these differences were not statistically significant. No consistent trend in complication rates was observed as the day progressed, and confidence intervals overlapped across all time periods.
Surgical start time does not appear to significantly influence intraoperative complication rates in cataract surgery. These findings support the safety of current scheduling practices within standard operating hours and suggest that concerns regarding time-of-day effects may be overstated in this context. Future research should focus on identifying other modifiable factors that may contribute to surgical errors and optimizing strategies to further enhance patient safety and surgical outcomes.
Core Tip: This large retrospective cohort study evaluates whether surgical start time influences intraoperative complication rates in cataract surgery. Analyzing over 32000 cases, we found no significant variation in complication rates across the surgical day. These findings challenge assumptions that surgeon fatigue or time of day meaningfully impact surgical performance within standard operating hours. By isolating surgeon-related factors in a high-volume, standardized procedure, this study provides robust evidence supporting current scheduling practices and highlights the need to investigate alternative contributors to surgical error.