SEP 20, 2010
In this editorial Burton J. Kushner, MD, questions the conclusions of a small study comparing the outcomes and economic cost of sequential surgery with simultaneous bilateral cataract surgery in infants with congenital cataracts. While the authors found no difference in the endophthalmitis rate or other serious surgical complications between the groups, they did find a difference in cost. There was a 21.9 percent reduction in cost with simultaneous surgery.
It's an unsurprising result, Dr. Kushner writes, given the low incidence of endophthalmitis after pediatric cataract surgery and the small sample size of just 27 children. More troubling is that the study doesn't adequately address the risks involved with simultaneous cataract surgery in children, writes Dr. Kushner. The study discusses the relative incidence of the risks but not the relative severity of the risks of simultaneous cataract surgery in children. He writes:
"Even if sequential surgery raises the incidence of anesthetic death somewhat, it does not impact the severity of dying; you can only die once-death is death. However, by increasing the likelihood of bilateral endophthalmitis by performing simultaneous surgery, even if the incidence is still small, the severity of that potential complication increases tremendously and by an incalculable amount."
Dr. Kushner concludes that cost saving should not play an important role in the timing of surgery for bilateral congenital cataracts, and fears that this study "will provide useful ammunition for those in control of the health care dollars to influence practice patterns in a manner that has devastating potential risks."