Perioperative Risk Assessment and Avoiding Overuse of Anesthesia Care for Routine Cataract Surgery—Reply

Abstract

COMMENT & RESPONSEIn Reply We thank Drs Nemet and Tuuminen and Dr Dalia and colleagues for their interest in our article. 1 Drs Nemet and Tuuminen's experiences in Finland add to the growing body of literature suggesting that complications after cataract surgery are exceedingly rare, even though anesthesia care for cataract surgery is used much more selectively at their institution than it is in the US. This approach to cataract surgery sedation is also the prevailing practice throughout the UK, 2 as well as at other dedicated eye care centers, 3,4 and has been shown to be safe and acceptable to patients in these settings.We agree with Dr Dalia and colleagues that undergoing an ambulatory procedure or a procedure performed outside the operating room does not automatically mean that these procedures should be considered low risk. 5 As the authors mentioned, some of the procedures we included, 1 such as cardiac catheterization and percutaneous coronary interventions (PCIs), are inherently higher risk than cataract surgery. 6 Yet our data showed 1 that although most cataract surgical procedures (lower risk) occurred with anesthesia care, almost all cardiac catheterizations and PCIs (higher risk) were being performed without anesthesia care. Our results raise the question of whether anesthesia care is being overused in cataract surgery while simultaneously being underused in cardiac catheterization and PCIs.Lastly, Dr Dalia and colleagues assert that the model results we shared in the online supplement 1 cannot account for all factors that affect the assignment of anesthesia care and/or the risk of developing perioperative complications. We agree that observational studies can only account for measured confounders. However, the reports of Drs Nemet and Tuuminen and others 2-4 support our study's conclusion that anesthesia care may be overused for cataract surgery. 1 Therefore, a pro-spective interventional trial is warranted to evaluate whether most cataract surgical procedures can be safely performed in the US without routine anesthesia care.