The Auckland Cataract Study: Risk Stratification for Phacoemulsification Surgery
American Journal of Ophthalmology, November 2016
Risk stratification can enable a surgeon to predict, and take steps to mitigate, a patient’s likelihood of complications well in advance of an operation. Kim et al. sought to validate the Muhtaseb and Buckinghamshire systems of risk stratification in a public teaching hospital. The authors confirmed that high scores with either system were predictive of intraoperative and postoperative complications from phacoemulsification cataract surgery.
The risk stratification systems were applied to the preoperative consultation notes for 500 cases of phacoemulsification surgery. Risk scores were calculated for each case by summing scores for each pertinent risk factor. Surgeon level, intraoperative and early postoperative complications, and corrected distance visual acuity (CDVA) were obtained from clinical and surgical notes.
Overall, 8.4% of cases had an intraoperative complication, and 7.6% of cases had a postoperative complication. The median Muhtaseb and Buckinghamshire scores were 0 and 1, respectively. For cases with Muhtaseb and Buckinghamshire scores of 0, intraoperative complication rates were 7.2% and 9.2%, respectively. For both systems, elevated preoperative risk scores (i.e., Muhtaseb >3, Buckinghamshire >6) were predictive of intraoperativecomplications and poorer CDVA. Higher Buckinghamshire scores also were associated with higher rates ofpostoperative complications.
Residents and fellows were statistically similar to attending physicians with regard to odds ratios for intraoperative or postoperative complications, even with case-mix adjustment. The authors cautioned that this finding may relate to the small number of high-scoring cases and/or to misappropriation of complications to attending surgeons when surgeons of different levels operated together.
The authors concluded that both risk stratification systems were valid in this setting. These systems, when standardized, have utility for informed consent, preoperative planning, surgical training, and comparison of outcomes among surgeons and centers. However, the authors emphasized the continuing value of qualitative risk assessments performed by the surgeon during preoperative consultation.
The original article can be found here.