The Cataract National Dataset electronic multicentre audit of 55 567 operations: risk stratification for posterior capsule rupture and vitreous loss

Abstract

Aims To identify and quantify risk factors for posterior capsule rupture or vitreous loss or both (PCR or VL or both) during cataract surgery and provide a method of composite risk assessment for individual operations. Methods The Cataract National Dataset was extracted on 55 567 operations from 12 National Health Service (NHS) Trusts using an electronic patient record (EPR) system between November 2001 and July 2006. Risk indicators for variations in the rate of 'PCR or VL or both' were identified by univariate and multivariate analyses. Adjusted odds ratios (ORs) were used to formulate a composite 'bespoke' risk for individual cases. Results Overall 'PCR or VL or both' rate was 1.92% (95% CI ¼ 1.81-2.04%). Risk indicators for this complication were increasing age, male gender, presence of glaucoma, diabetic retinopathy, brunescent/white cataract, no fundal view/vitreous opacities, pseudoexfoliation/phacodonesis, reducing pupil size, axial length X26.0 mm, the use of the ablocker doxazosin, inability to lie flat and trainee surgeons performing operations. Adjusted ORs for these variables are used to estimate overall composite risk across multiple risk indicators in the form of a predicted probability of PCR or VL or both. Predicted probability for this complication ranged from less than 0.75% to more than 75%, depending on risk profile of individual operations. Conclusions Higher-risk cases can be predicted, thus better informing the consent process and allowing surgeons to take appropriate precautions. Case-mix is a major determinant of the probability of an intraoperative complication. A simple composite risk estimation system has been developed.

The conjunctival bacterial pattern of diabetics undergoing cataract surgery

“…34,35,37 However, the concomitance of nephropathy and retinopathy represents a worse state in the diabetes progression. 34,35 This fact indicates that, apart from the risk of diabetics with retinopathy having a higher rate of posterior capsule rupture during the cataract operations 22 (a surgical complication associated with an increased incidence of PE 15,18 ), diabetics with renal function impairment have a potential increased risk of bacterial contamination during that operation. In our study, 14.11% of the self-reported diabetics had an abnormally high blood creatinine level; among those, the proportion in the diabetics type I group is higher than that in the type II group (Table 5).…”

“…Nevertheless, we can identify patients with an increased risk of PE. Thus, the aim of this study is to ascertain whether the conjunctival flora of diabetic patients undergoing cataract surgery present some peculiarity that could offer some explanation for the often found association of diabetes and PE, apart from the known susceptibility of diabetics with retinopathy for having posterior capsular rupture during the cataract operation, 22 as not many of these surgical complications become a PE case. 15 For this purpose, we compare the conjunctival bacteria of diabetics and non-diabetics who underwent cataract operation in our tertiary referral hospital.…”

The Cataract National Dataset electronic multicentre audit of 55 567 operations: antiplatelet and anticoagulant medications

“…This unexpected finding is difficult to understand but could reflect 'surgical difficulty', where there is increased superficial haemorrhage or simply the fact that users were older, an association highlighted in our previously reported multivariate analysis of risk factors for posterior capsule rupture or vitreous loss or both. 26 Data for this study were extracted from the EPR system in accordance with the CND and some of the potential shortcomings of the analysis in this study may reflect limitations of the CND. Most notable for this analysis, there is no indication in the extracted data as to whether the anticoagulant/antiplatelet medication was stopped before surgery or, if the patient was on warfarin, whether an INR was performed or its result.…”

United Kingdom National Ophthalmology Database Study: Diabetic Retinopathy; Report 1: prevalence of centre-involving diabetic macular oedema and other grades of maculopathy and retinopathy in hospital eye services

“…This project builds on a series of studies where clinicians have pooled EMR data to update benchmark standards for cataract and vitreo-retinal surgery. [15][16][17][18][19] …”