Surgical outcomes in phacoemulsification after application of a risk stratification system

Abstract

BackgroundThe purpose of this study was to determine whether application of a risk stratification system during preoperative assessment of cataract patients and subsequent allocation of patients to surgeons with matching experience may reduce intraoperative complications.MethodsNine hundred and fifty-three consecutive patients (1109 eyes) undergoing phacoemulsification cataract surgery were assigned to two groups, ie, group A (n = 498 patients, 578 eyes) and group B (n = 455 patients, 531 eyes). Patients from group A were allocated to surgeons with varying experience with only a rough estimate of the complexity of their surgery. Patients from group B were assigned to three risk groups (no added risk, low risk, and moderate-high risk) according to risk factors established during their preoperative assessment and were respectively allocated to resident surgeons, low-volume surgeons, or high-volume surgeons. Data were collected and entered into a computerized database. The intraoperative complication rate was calculated for each group.ResultsThe intraoperative complication rate was significantly lower in group B than in group A (group A, 5.88%; group B, 3.2%; P < 0.05). Patients from group B with no added risk and allocated to resident surgeons had a significantly lower rate of intraoperative complications than those from group A allocated to resident surgeons (group A, 7.2%; group B, 3.08%; P < 0.05).ConclusionOur study demonstrates that allocation of cataract patients to surgeons matched for experience according to a uniform and reliable preoperative assessment of their risk of complications allows for better surgical outcomes, especially for resident surgeons.

Auckland Cataract Study IV: Practical application of NZCRS cataract risk stratification to reduce phacoemulsification complications

“…Kim et al reported the significant benefits of cataract surgery risk stratification in New Zealand and Han et al subsequently reported a refined risk stratification system, the New Zealand Cataract Risk Stratification system. This system (Table ) incorporates elements from the Muhtaseb system, plus one higher risk parameter (score > 3) and three new elements with additional scoring for: use of oral alpha‐antagonists; prior vitrectomy, due to predisposition to intraoperative complications and “only eye” patients based on feedback on patient functioning from earlier phases of the study . Subsequently, we reported that the NZCRS system systematically identifies a greater proportion of cataract cases at higher risk of complication than the earlier Muhtaseb system …”

Comparison of occlusion break responses and vacuum rise times of phacoemulsification systems

“…Occlusion break surge can cause the anterior chamber to shallow [9,10] or cause the iris or posterior capsule to move toward the phacoemulsification tip, increasing the potential risk of posterior capsule rupture or iris trauma [5,11]. …”

<p>A Comparative Assessment of Intraoperative Complication Rates in Resident-Performed Phacoemulsification Surgeries According to Najjar-Awwad Preoperative Risk Stratification</p>

“…This is in stark contrast with the results of a study by Tsinopoulos et al, who found a significantly higher rate of intraoperative complications in phacoemulsification surgeries performed by residents with varying experience compared with those performed by residents after applying a risk stratification system (7.2% vs 3%). 12 This inconsistency can be attributed to the difference in risk stratification systems, as Tsinopoulos et al used the risk score developed by Muhtaseb, which categorizes the patients into three groups according to their preoperative risk for phacoemulsification, 30 but we used the Najjar-Awwad risk score. The difference in results can also be ascribed to the differences in sample sizes and designs of the two studies.…”

“…Therefore, it is paramount to strike a balance between training programs of resident surgeons and patient safety in operative procedures such as phacoemulsification. [10][11][12][13][14][15][16] In the present study, we compared major intraoperative surgical complications of resident-performed phacoemulsification surgeries between cases with low intraoperative risk and random cases with unknown intraoperative risk. The length of ophthalmology residency in Iran is 4 years and residents are allowed to perform phacoemulsification surgery under supervision in their third and fourth years.…”