Evidence-based consent and indications for general anaesthesia in cataract surgery

Poster Details

First Author: A.Hussain UK

Co Author(s):    V. Ho   C. Emmett   P. Lewis        

Abstract Details

Purpose:

To evaluate patient outcome from General Anaesthesia (GA) compared to Local Anaesthesia (LA) for cataract surgery and to ascertain indications for the type of anaesthetic used. This study aims to improve the level of information of anaesthetic risk given to patients and to better guide clinicians on indications determining anaesthetic choice.

Setting:

Single-centre case controlled study performed at a district general hospital with a large throughput of cataract surgery patients.

Methods:

A review of hospital morbidity and mortality data 30 day post cataract surgery over a 3 year period was performed. The indications for the use of GA to the usual choice of LA were evaluated through patient notes. An analysis of expected versus observed frequencies in local and general anaesthesia was performed. The results have provided evidence to provide a more robust consent process for patients having GA for cataract surgery.

Results:

A total of 3621 patients had cataract surgery at our unit over a 3 year period. Of these, 555 (15.1%) had a general anaesthetic. The mean age for both groups was 71.7 years for GA and 73.2 years for LA. In total there were 10 patients who had died within 30 days of surgery with 2 of these having had GA for their surgery, and the remaining LA. There was no significant difference between the two groups for mortality within 30 days in a cross-tabulation analysis. There had been a gradual rise in the number of patients having GA for elective surgery over the 3 year period. The commonest reasons for GA were patient anxiety and a medical condition deemed to contraindicate the surgery under LA.

Conclusions:

Our study has confirmed that with recent advances in GA induction and maintenance, there is now no significant difference in mortality within the first 30 days of surgery between GA and LA for elective cataract surgery in suitable patients. Although this evidence can form part of the consenting process for surgery to allow greater patient choice, it is paramount that the risks of GA are balanced against the general health of the patient. The vast majority of patients continue to have this surgery under LA and GA should remain an option mainly to improve the outcome and experience of the surgery for the patient. FINANCIAL DISCLOSURE?: No