Kaiser Klemens Paul, Turgut Ferhat, Ernst Sophie-Christin Kornelia, Somfai Gabor Mark, Zoellin Jay Rodney Toby, Saad Amr, Davolio Noah, Hornberger Ute, Nilius Henning, Heussen Julie Susan, Becker Matthias Dieter, Heussen Florian M
Department of Ophthalmology, Stadtspital Zürich, Zurich, Switzerland.
Department of Ophthalmology, Goethe-University, Frankfurt am Main, Germany.
Clin Ophthalmol. 2025 Sep 9;19:3307-3316. doi: 10.2147/OPTH.S544354. eCollection 2025.
This study evaluates the impact of a modified risk stratification system on intraoperative complication rates in cataract surgeries conducted at a Swiss Public Hospital.
In this retrospective study cataract surgeries were analyzed before and after implementation of the Triemli Cataract Score (TCS) at a public referral hospital. The TCS was utilized to classify patients preoperatively based on their risk profile, categorizing cases into three levels of complexity: "routine", "complex", and "highly complex". The primary endpoint is the frequency of intraoperative complications pre-/post-TCS implementation, as well as alignment with the designated risk groups.
A total of 1776 eyes were included in the study, with 704 eyes (39.6%) assessed prior to and 1072 (60.4%) post-TCS implementation. Overall, intraoperative complications were observed in 146 surgeries (8.2%), with a higher incidence observed before (9.5%) compared to post-TCS (7.4%; p=0.054). Post-TCS, 625 (63.2%) were classified as "routine", 250 eyes (25.3%) as "complex", and 113 eyes (11.4%) as "highly complex", based on their risk factors. The intraoperative complication rate varied significantly among these groups (p=0.014): the lowest rate was seen in the routine group (5.6%), followed by the highly complex group (8.8%), and the highest in the complex group (11.2%).
Implementing a risk stratification system for cataract surgery enables efficient and consistent preoperative categorization of patients into defined risk groups. This approach has the potential to reduce intraoperative complications, improve the comparability of study outcomes, streamline the classification process for surgeons, and establish structured checkpoints for training ophthalmic surgeons.
本研究评估了一种改良的风险分层系统对一家瑞士公立医院进行的白内障手术术中并发症发生率的影响。
在这项回顾性研究中，对一家公立转诊医院实施特里姆利白内障评分（TCS）前后的白内障手术进行了分析。TCS用于术前根据患者的风险状况对患者进行分类，将病例分为三个复杂程度级别：“常规”、“复杂”和“高度复杂”。主要终点是TCS实施前后术中并发症的发生率，以及与指定风险组的一致性。
本研究共纳入1776只眼，其中704只眼（39.6%）在TCS实施前进行评估，1072只眼（60.4%）在TCS实施后进行评估。总体而言，146例手术（8.2%）中观察到术中并发症，TCS实施前的发生率（9.5%）高于TCS实施后（7.4%；p=0.054）。根据风险因素，TCS实施后，625只眼（63.2%）被分类为“常规”，250只眼（25.3%）为“复杂”，113只眼（11.4%）为“高度复杂”。这些组之间的术中并发症发生率差异显著（p=0.014）：常规组发生率最低（5.6%），其次是高度复杂组（8.8%），复杂组最高（11.2%）。
为白内障手术实施风险分层系统能够在术前将患者高效、一致地分类到明确的风险组中。这种方法有可能减少术中并发症，提高研究结果的可比性，简化外科医生的分类过程，并为眼科外科医生培训建立结构化的检查点。
