Routine cataract surgery without the presence of an anaesthetist

Kent-Smith, Brian T; Wallace, G M

doi:10.1111/j.1442-9071.2007.01553.x

Cited by 5 publications

(5 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We also found that the rate of systemic perioperative complications was similar between ophthalmologists who sometimes or always used anesthesia care compared with those who never did. The study results are consistent with other studies that show that complication rates for cataract surgery are not higher among patients who undergo cataract surgery without anesthesia care when using protocolized approaches and trained staff . In a large retrospective case series from Kaiser Permanente Colorado, where ophthalmologists routinely perform cataract surgery with nurse sedation in minor procedure rooms, there were minimal perioperative and ophthalmologic complications and comparable outcomes with cataract surgeries performed at ambulatory surgery centers .…”

Section: Discussionsupporting

confidence: 87%

Anesthesia Care for Cataract Surgery in Medicare Beneficiaries

et al. 2022

View full text Add to dashboard Cite

ImportanceCataract surgery in the US is routinely performed with anesthesia care, whereas anesthesia care for other elective, low-risk, outpatient procedures is applied more selectively.ObjectiveTo identify predictors of anesthesia care in Medicare beneficiaries undergoing cataract surgery and evaluate anesthesia care for cataract surgery compared with other elective, low-risk, outpatient procedures.Design, Setting, and ParticipantsThis population-based, retrospective observational cohort study included Medicare beneficiaries 66 years or older who underwent cataract surgery in 2017. The data were analyzed from August 2020 through May 2021.Interventions (for clinical trials) or Exposures (for observational studies)Anesthesia care during elective, low-risk, outpatient procedures.Main Outcomes and MeasuresPrevalence of anesthesia care during cataract surgery compared with other low-risk procedures; association of anesthesia care with patient, clinician, and health system characteristics; and proportion of patients experiencing a systemic complication within 7 days of cataract surgery compared with patients undergoing other low-risk procedures.ResultsAmong 36 652 cataract surgery patients, the mean (SD) age was 74.7 (6.1) years; 21 690 (59.2%) were female; 2200 (6.6%) were Black and 32 049 (87.4%) were White. Anesthesia care was more common among patients undergoing cataract surgery compared with patients undergoing other low-risk procedures (89.8% vs range of &lt;1% to 70.2%). Neither the patient’s age (adjusted odds ratio, 1.01; 95% CI, 1.00-1.02; P = .01) nor Charlson Comorbidity Index (CCI) score (CCI of ≥3: adjusted odds ratio, 1.06; 95% CI, 0.95-1.18; P = .28; reference, CCI score of 0-1) was strongly associated with anesthesia care for cataract surgery, but a model comprising a single variable identifying the ophthalmologist predicted anesthesia care with a C statistic of 0.96. Approximately 6.0% of ophthalmologists never used anesthesia care, 76.6% always used anesthesia care, and 17.4% used it for only a subset of patients. Fewer cataract surgery patients experienced systemic complications within 7 days (2833 [7.7%]), even when limited to patients of ophthalmologists who never used anesthesia care (108 [7.4%]), than patients undergoing other low-risk procedures (range, 13.2%-52.2%).Conclusions and RelevanceThe results of this cohort study suggest that systemic complications occurred less frequently after cataract surgery compared with other elective, low-risk, outpatient procedures during which anesthesia care was less commonly used. Anesthesia care was not associated with patient characteristics, such as older age or worse health status, but with the ophthalmologists’ usual approach to cataract surgery sedation. The study findings suggest an opportunity to use anesthesia care more selectively in patients undergoing cataract surgery.

show abstract

Section: Discussionsupporting

confidence: 87%

Anesthesia Care for Cataract Surgery in Medicare Beneficiaries

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Our data revealed half the patients requiring anaesthetist intervention had minimal comorbidities, emphasizing that we should not underestimate the potential risks of cataract surgery, especially for older patients. Most routine cataract surgery performed in Australia and New Zealand has supervised anaesthetic care by an anaesthetist although the need for an anaesthetist to be present has been questioned by several authors 27,30,31 . The option of replacing an anaesthetist with a non‐medically trained, more cost‐effective professional, such as a nurse with advanced training in anaesthesia and resuscitation, has been proposed in response to the increasing costs of cataract surgery and shortage of specialist anaesthetists.…”

Section: Discussionmentioning

confidence: 99%

“…Most routine cataract surgery performed in Australia and New Zealand has supervised anaesthetic care by an anaesthetist although the need for an anaesthetist to be present has been questioned by several authors. 27,30,31 The option of replacing an anaesthetist with a nonmedically trained, more cost-effective professional, such as a nurse with advanced training in anaesthesia and resuscitation, has been proposed in response to the increasing costs of cataract surgery and shortage of specialist anaesthetists. Further investigation of this model is required, and patient preference must be considered when proposed health-care changes are driven by cost-cutting, as many patients feel secure and relaxed knowing an anaesthetist is attending them during their surgery.…”

Section: Discussionmentioning

confidence: 99%

Adverse medical events associated with cataract surgery performed under topical anaesthesia

Sharwood

Thomas

Roberts

2008

Clinical Exper Ophthalmology

View full text Add to dashboard Cite

show abstract

“…4,8,9 Thus, with the increasing use of topical anesthesia and low risk for perioperative medical complications intraoperatively, several studies have tried to assess the factors associated with monitored anesthesia care during cataract surgery. [10][11][12][13][14][15] For example, intravenous access is essential if peribulbar or retrobulbar anesthetic techniques are used. 16,17 However, cataract surgery guidelines suggest that intravenous access might not be required routinely for topical or sub-Tenon anesthesia.…”

mentioning

confidence: 99%