Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Department of Ophthalmology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand.
Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Am J Ophthalmol. 2019 Jan;197:114-120. doi: 10.1016/j.ajo.2018.09.026. Epub 2018 Sep 29.
To assess intraoperative complications of phacoemulsification surgery in public teaching hospital settings using modified preoperative risk stratification systems.
Prospective cohort study.
Preoperative risk stratification of 500 consecutive cataract cases using the New Zealand Cataract Risk Stratification (NZCRS) scoring system. Recommended allocation of higher-risk phacoemulsification procedures to experienced surgeons in public teaching hospital setting.
Intraoperative complications relative to adherence to stratification recommendations.
NZCRS classified 192 cases (38%) as high-risk, recommended for fellows or consultants (attendings). Primary surgeons were residents (n = 142, 28%), fellows (n = 88, 18%), and consultants (n = 270, 54%). Overall rate (N = 500) of any intraoperative complication was 5.0%. Where NZCRS scoring recommendations were observed (n = 448) the intraoperative complication rate was 4.5% but in "nonadherence" cases (n = 52 residents operating on higher-risk cases) this nearly doubled (9.6%). Postoperative complications occurred in 5.2%, primarily cystoid macular edema (3.7%). Postoperatively, mean unaided visual acuity was 6/12 (20/40) and best-corrected visual acuity improved from 6/20 (20/63) preoperatively to 6/10 (20/32) postoperatively (P < .05).
The NZCRS system aids identification of higher-risk cataract cases and appropriate case-to-surgeon allocation and may increase surgeon awareness of risk factors. Compared to 2 previous studies under similar conditions in the same institution, the NZCRS system was associated with a 40% reduction in intraoperative complications (8.4% to 5%). The rate of posterior capsular tear was 0.6% (P = .035) compared to 2.6% in baseline phase and 1.4% in a prior risk stratification phase. Risk stratification seems to reduce intraoperative phacoemulsification complications in public teaching hospital settings.
使用改良的术前风险分层系统评估公立医院环境下的超声乳化白内障手术的术中并发症。
前瞻性队列研究。
使用新西兰白内障风险分层（NZCRS）评分系统对 500 例连续白内障病例进行术前风险分层。建议在公立医院环境中将高风险的超声乳化手术分配给经验丰富的外科医生。
与分层建议的遵守情况相关的术中并发症。
NZCRS 将 192 例（38%）病例归类为高风险，建议由研究员或顾问（主治医生）进行手术。初级外科医生为住院医师（n=142，28%）、研究员（n=88，18%）和顾问（n=270，54%）。500 例患者中（500）任何术中并发症的总发生率为 5.0%。在观察到 NZCRS 评分建议的情况下（n=448），术中并发症发生率为 4.5%，但在“不遵守”的情况下（n=52 名住院医师对高风险病例进行手术），该比例几乎翻了一番（9.6%）。术后并发症发生率为 5.2%，主要为囊样黄斑水肿（3.7%）。术后，未矫正视力平均为 6/12（20/40），最佳矫正视力从术前的 6/20（20/63）提高到术后的 6/10（20/32）（P<.05）。
NZCRS 系统有助于识别高风险白内障病例和适当的病例与外科医生的分配，并可能提高外科医生对风险因素的认识。与同一机构类似条件下的前 2 项研究相比，NZCRS 系统与术中并发症减少 40%（8.4%至 5%）相关。后囊破裂率为 0.6%（P=.035），而基线期为 2.6%，风险分层期为 1.4%。风险分层似乎可以减少公立医院环境下的超声乳化白内障手术术中并发症。
