Validation of Najjar-Awwad cataract surgery risk score for resident phacoemulsification surgery

Abstract

PURPOSE To validate the Najjar-Awwad cataract surgery risk score for residents, which has been proposed to predict surgical complexity and risk. SETTING Two urban public county hospitals. DESIGN Case series. METHODS Phacoemulsification cataract surgeries performed by residents between January 2005 and April 2008 were retrospectively reviewed. The cataract risk score was calculated retrospectively. Intraoperative complications included posterior and anterior capsular tears, vitreous prolapse, dropped nucleus, and conversion to manual extracapsular cataract extraction. RESULTS Of the cases performed by 33 residents, 1833 met the inclusion criteria. There were 120 complications (6.5%); the rate of complications involving vitreous prolapse or loss (including dropped nucleus) was 3.2%. Significant risk factors in the risk score associated with intraoperative complications were dense nuclear sclerosis (odds ratio [OR], 2.08; 95% confidence interval [CI], 1.32–3.26; P = .004) and poor red reflex (OR, 2.10; 95% CI, 1.45–3.06; P = .00007). Cataract risk scores ranged from 3 to 16. The score was less than 5 in 85 cases (4.6%) and less than 7 in 885 cases (48.3%). The OR for complications increased significantly when the risk score was higher than 6 (OR, 2.11; 95% CI, 1.42–3.14; P = .0002). CONCLUSIONS Although the Najjar-Awwad cataract surgery risk score can be used to predict intraoperative complications at the time of cataract surgery, the complication rate did not significantly increase until the score reached 7. There were few cases with scores lower than 5 in these county hospital populations. Beginning surgeons should be given cases with a risk score of less than 7. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Risk factors for vitreous complications in resident-performed phacoemulsification surgery

“…Cataract cases are usually not as complex at John Peter Smith. In a previous review of 1833 cases, 27 the Najjar-Awwad cataract surgery risk score averaged 6.79 at John Peter Smith and 6.99 at Parkland (P=0.023, unpublished data). While there was a trend towards fewer complications in the second half of the third year of residency when compared to the first half, the difference was not statistically significant (P=0.128).…”

“…14 Najjar and Awwad 26 devised a cataract risk score for beginning residents that has recently been validated. 27 These scoring systems were built using a combination of literature search and expert opinion. Many factors in these systems may be superfluous, while others may be missing.…”

Characterizing the learning curve in phacoemulsification

“…Rutar et al 5 found an increase in complication rates in surgeries performed by residents when there was a dense nuclear sclerotic cataract or zonular weakness. Blomquist et al 8 also found an increased risk for complications among residents performing complex cataract surgery, especially in cases with a dense nuclear sclerotic cataract or a lack of the red reflex. This may point to the need to have, when feasible, an experienced colleague help recent resident graduates in performing complex cataract cases.…”

Complication rates of phacoemulsification and manual small-incision cataract surgery at Aravind Eye Hospital

“…Previous studies 16,23,31,32 that also excluded patients with preoperative pathology impairing vision have reported visual outcomes of 6/12 or better in 86% to 91% of patients with complications. Overall, only 4 manual SICS patients and 1 phacoemulsification patient experienced intraoperative complications that resulted in a CDVA worse than 6/60 at the 1-month postoperative visit.…”