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Surgical outcomes in phacoemulsification after application of a risk stratification system

Authors Tsinopoulos IT, Lamprogiannis LP, Tsaousis KT, Mataftsi A, Symeonidis C, Chalvatzis NT, Dimitrakos SA

Received 13 January 2013

Accepted for publication 5 February 2013

Published 16 May 2013 Volume 2013:7 Pages 895—899


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Ioannis T Tsinopoulos,1 Lampros P Lamprogiannis,2 Konstantinos T Tsaousis,1 Asimina Mataftsi,1 Chrysanthos Symeonidis,1 Nikolaos T Chalvatzis,1 Stavros A Dimitrakos1

1Second Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece; 2First Department of Ophthalmology, Aristotle University of Thessaloniki, AHEPA General Hospital, Thessaloniki, Greece

Background: The purpose of this study was to determine whether application of a risk stratification system during preoperative assessment of cataract patients and subsequent allocation of patients to surgeons with matching experience may reduce intraoperative complications.
Methods: Nine hundred and fifty-three consecutive patients (1109 eyes) undergoing phacoemulsification cataract surgery were assigned to two groups, ie, group A (n = 498 patients, 578 eyes) and group B (n = 455 patients, 531 eyes). Patients from group A were allocated to surgeons with varying experience with only a rough estimate of the complexity of their surgery. Patients from group B were assigned to three risk groups (no added risk, low risk, and moderate-high risk) according to risk factors established during their preoperative assessment and were respectively allocated to resident surgeons, low-volume surgeons, or high-volume surgeons. Data were collected and entered into a computerized database. The intraoperative complication rate was calculated for each group.
Results: The intraoperative complication rate was significantly lower in group B than in group A (group A, 5.88%; group B, 3.2%; P < 0.05). Patients from group B with no added risk and allocated to resident surgeons had a significantly lower rate of intraoperative complications than those from group A allocated to resident surgeons (group A, 7.2%; group B, 3.08%; P < 0.05).
Conclusion: Our study demonstrates that allocation of cataract patients to surgeons matched for experience according to a uniform and reliable preoperative assessment of their risk of complications allows for better surgical outcomes, especially for resident surgeons.

Keywords: cataract, risk stratification, complications, resident

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