What Determines Patient Satisfaction with Cataract Care Under Topical Local Anesthesia and Monitored Sedation in a Community Hospital Setting?

Abstract

The Iowa Satisfaction with Anesthesia Scale (ISAS) is a reliable and valid tool to measure patient satisfaction with monitored anesthesia care. We used the ISAS to discover determinants of patient satisfaction with cataract care under topical local anesthesia and monitored sedation in a small community hospital. The ISAS (scored 1 to 6) was administered to 306 patients immediately after cataract surgery. All patients received topical local anesthesia and IV sedation administered by an anesthesiologist. Patient satisfaction was high: mean ISAS was 5.6 (sd 0.46; range: 3.3-6.0). The incidence of intraoperative and postoperative pain was 13% and 37%; other adverse events were infrequent (<5%). In multivariable logistic regression, significant predictors of satisfaction were postoperative pain (odds ratio [OR]: 4.84; 99% confidence interval [CI]: 2.21, 10.60), surgeon (OR: 0.21; 99% CI: 0.05, 0.91), and preoperative anxiety (OR: 1.17; 99% CI: 1.03, 1.34). ISAS mean scores (OR = 0.28; 99% CI: 0.13, 0.59) and preoperative anxiety (OR = 1.12; 99% CI: 0.99, 1.28) emerged as significant predictors of low rating of quality of experience. Our results indicate that the ISAS can be used to track patient satisfaction with monitored cataract care. Pain during and after cataract surgery is common and is a major reason for lower patient satisfaction with their cataract care.

Recovery after nasal surgery vs. tonsillectomy: discriminant validation of the Postoperative Quality of Recovery Scale

“…Patient satisfaction with surgery is typically very high [16][17][18] and is a poor discriminator of quality of recovery. 19 We have previously shown that the most important contributor to poor satisfaction is persistent pain or nausea.…”

Local anesthesia for cataract surgery

“…51 Perceived pain level thus determines patient's preference for the anesthesia technique and is an important factor in the selection of an optimum strategy for anesthesia management during cataract surgery. During the anesthesia administration phase, topical anesthesia, unlike injection-type anesthesia modalities, is associated with minimal discomfort.…”

“…Complications of sedation include excessive restlessness, sudden movement, and airway obstruction, which can significantly increase the risk of the surgery. 6,51,56 If the patient is sedated, monitoring is required. The anesthetist should be present and responsible for the intravenous (IV) sedation.…”

Validación al español de la escala «The Iowa satisfaction with anesthesia scale (ISAS)» para cuidado anestésico monitorizado en cirugía de oftalmología

“…Hay publicaciones que referencian la utilidad, validez y confiabilidad de la escala EISA en estudios clínicos [4][5][6][7][8][9][10][11] . Entre estos, Dexter y Candioti 10 demostraron que la escala EISA se puede utilizar como medida de desenlace primario en ensayos clínicos multicéntricos.…”