Can the use and application of a risk stratification system, preoperatively, reduce intraoperative complications during phakoemulsification?

Session Details

Session Title: Cataract I
Session Date/Time: Friday 26/02/2016 | 10:30-12:30
Paper Time: 11:45
Venue: MC3 Room
First Author: : T.Young-Zvandasara UK
Co Author(s): :    M. Elmi   J. Hansell   M. Muhtaseb        

Abstract Details

Purpose:

To assess if the application of a simple, robust, validated preoperative scoring system can reduce the rates of intraoperative complications if patients are assigned to the appropriately experienced surgeon’s list and surgical time is modified accordingly.

Setting:

Department of Ophthalmology. Royal Glamorgan Hospital. Wales, United Kingdom.

Methods:

Five hundred and eight (508) consecutive patients undergoing phakoemulsification cataract surgery were assessed preoperatively according to weighted criteria. According to the points of risk they accumulated using this system; the patients were preoperatively allocated to one of four risk groups. Data was collected electronically at surgery on the occurrence of intraoperative complications. The total rate of intraoperative complications for each risk group as well as the rate of each reported complication for each risk group was calculated.

Results:

The rate of intraoperative complications through the risk groups was: 1 = 0.6%, 2 = 0.6%, 3 = 0.3%, and 4 = 0 % (p<0.001). Thirty seven percent 37% (n=189) of all operations were performed on eyes of patients carrying at least one risk factor for intraoperative complications. The overall rate of any intraoperative complication was 1.4% (n=7). There was a 0.2% (n=1) rate of a posterior capsule tear with no vitreous loss but requiring a sulcus 3 piece IOL (Risk group 1 case). Surgical manipulation was noted to also increase through the groups, e.g. iris stretching manoeuvres.

Conclusions:

We have demonstrated how a risk stratification system that allocates patients to lists based on predicted risk as well as allowing adequate theatre time can reduce the rates of intraoperative complications. We feel the risk stratification system allows more structured training as the lower risk group cases are operated on by a trainee with the appropriate experience and receives support from a consultant who is aware of the risk score. The risk stratification system allows for better planning of surgical lists and is a useful safety tool.

Financial Disclosure:

NONE