Posters

Is Murphy’s Law applicable in cataract surgery? A retrospective analysis

Poster Details

First Author: D.Ho UK

Co Author(s):    T. Parmar   S. Kadares   S. Tolley   G. Williams           

Abstract Details

Purpose:

Around 400,000 cataract operations are performed each year in the UK, with a complication rate of 1.95%. Complication costs are estimated at >€14.6 million per year. Cataract surgeries are occasionally cancelled due to patient ill health. To fully utilise theatre time, agreeable patients are sometimes directly sent from assessment clinics to the operating table on the same day. Murphy’s Law states that ‘if anything can go wrong, it will’. This study investigates the validity of Murphy’s Law in cataract surgeries – whether last-minute ‘add-on’ cases have higher complication rates.

Setting:

‘Add-on’ cataract surgeries performed in Singleton Hospital, Swansea between January 2016 and January 2018.

Methods:

We conducted a retrospective study using data extracted from the electronic patient record of cataract surgeries performed in Singleton Hospital, Swansea between January 2016 and January 2018, including the allocated patient risk stratification groups as described by Muhtaseb (2004), and the presence of any complications. Patients who had unscheduled cataract surgeries were compared against departmental audit data of all cataract cases performed between 2015 and 2016, a total of 4289 operations.

Results:

We identified 227 patients who had cataract surgery performed on the same day as their pre-operative assessment. There were three posterior capsule ruptures (PCRs), including one dropped nucleus, and three zonular dehiscence. These represent a complication rate of 2.64%. Of the 4289 cataract surgeries performed 2015-2016, there were 44 PCRs, including 4 dropped nuclei, and 8 zonular dehiscence, representing a complication rate of 1.21%. Statistical analysis comparing these complication rates demonstrates significance with p=0.04. Difficulty levels between the two groups were comparable, with an average risk stratification grade of 1.7 and 1.66 in the add-on and pre-scheduled groups respectively.

Conclusions:

It was previously hypothesised that confirmation bias might highlight complications amongst add-on patients above the others. Our study demonstrated that there is indeed significantly higher rate of complications in this group. Our study did not capture the psychological factors affecting the surgeon, induced by the unexpected case addition, or the patients’ emotional status or state of preparedness, which might have implication in their ability to obey the surgeon’s commands during their surgeries, such as adjusting their heads to the desired positions or lying still. Further studies on the relationship between patient/surgeon mental status and complication rates are warranted.

Financial Disclosure:

None