The authors prospectively collected data on 1135 consecutive patients undergoing cataract surgery. They were risk stratified according to categories – A (no additional risk factors, 0 points), B (vitrectomy, corneal scarring, small pupil less than 3mm, shallow anterior chamber less than 2.5mm, age over 88 years, high ametropia of more than 6 dioptres, posterior capsular plaque or posterior polar cataract, 1 point each) and C (dense / total / white or brunescent cataract, pseudoexfoliation, phacodonesis, 3 points each). The patients were risk stratified according to number of total points – group 1 (no added risk) 0 points, group 2 (low risk) 1-2 points, group 3 (moderate risk) 3-5 points, group 4 (high risk) 6 or more points. Patients were allocated more time in theatre if Risk Group 2 (x1.2 time), Group 3 (x1.5 time) or Group 4 (x2 time). Risk group allocation also allowed for allocation to surgical lists attended by surgeons or appropriate seniority and experience. In this study, operations were carried out by consultants (39.5%), associate specialists or staff grade doctors (37.1%), trainee ST1-3 (10.1%) and trainee ST4-7 (13.3%). Sixty-three percent of patients were in risk group 1, 26.3% in group 2, 9.5% in group 3 and 1.1% in group 4. The overall risk of intraoperative complication was 1.2%, of which 0.4% were posterior capsular rupture (PCR). The authors acknowledge low patient numbers in certain groups and therefore the difficulty in providing meaningful conclusions. However, they conclude that the risk stratification system allocated patients to lists based on predicted risk as well as allowing adequate theatre time and required expertise where it was most needed. They propose that this system allows more structured training as the lower risk group cases are operated on by a trainee with the appropriate experience. It also allows for better planning of surgical lists which can be used as a transition for trainees deemed to be of sufficient experience for more challenging cases under adequate supervision.
Risk stratification to reduce intraoperative cataract surgical complications
Reviewed by Kurt Spiteri Cornish
Can applying a risk stratification system, preoperatively, reduce intraoperative complications during phacoemulsification?
CONTRIBUTOR
Kurt Spiteri Cornish
Sheffield Teaching Hospitals NHS Trust, London, UK.
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