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van den Heuvel SF, Jonker P, Hoeks SE, Ismail SY, Stolker RJ, Korstanje JWH. The effect of stand-alone and additional preoperative video education on patients' knowledge of anaesthesia: A randomised controlled trial. Eur J Anaesthesiol 2025; 42:313-323. [PMID: 39704038 PMCID: PMC11872255 DOI: 10.1097/eja.0000000000002109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2024]
Abstract
BACKGROUND Fully digital preoperative information could save valuable time and resources. However, compared with face to face consultations, equivalent levels of safety, patient satisfaction and participation need to be maintained when using other methods to inform patients. This trial compared knowledge retention between preoperative stand-alone video education and face-to-face education by an anaesthesiologist. OBJECTIVES To assess if video education, alone or combined with face-to-face education, leads to better knowledge retention more than conventional face-to-face education. DESIGN A randomised controlled trial with four arms: Video, Anaesthesiologist, Video & Anaesthesiologist, and Reference for baseline measurements and exploration of a test-enhanced learning effect. SETTING A Dutch tertiary care centre from February 2022 to February 2023. PATIENTS A total of 767 adult patients undergoing preoperative consultation for elective non-cardiothoracic surgery, with 677 included in the complete case analysis. INTERVENTIONS Stand-alone preoperative video education and video education in combination with face-to-face education in the preoperative outpatient clinic. MAIN OUTCOME MEASURES Primary outcome, measured by the Rotterdam Anaesthesia Knowledge Questionnaire, was knowledge retention on day 0. Secondary outcomes included knowledge retention at 14 and 42 days, preoperative anxiety, and the need for additional information using the Amsterdam Preoperative Anxiety and Information Scale. Other outcomes were satisfaction, self-assessed knowledge, and test-enhanced learning effect. RESULTS Stand-alone video education led to higher Rotterdam Anaesthesia Knowledge Questionnaire scores than face-to-face education on day 0: median [IQR], 87.5 [81.3 to 93.8] vs. 81.3 [68.8 to 87.5], P < 0.001. Combined education in the "Video & Anaesthesiologist" group led to better knowledge retention compared with both the "Anaesthesiologist" group and the Video group: 93.8 [87.5 to 93.8] vs. 81.3 [68.8 to 87.5], P < 0.001; 93.8 [87.5 to 93.8] vs. 87.5 [81.3 to 93.8], P = 0.01, respectively. No differences in the patients' preoperative anxiety and satisfaction levels were found. CONCLUSION Compared with face-to-face education by an anaesthesiologist, stand-alone video and combined video education improve short-term knowledge retention, without increasing patient anxiety. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05188547.
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Affiliation(s)
- Sander F van den Heuvel
- From the Department of Anaesthesiology, Erasmus MC University Medical Centre Rotterdam, CA Rotterdam, Netherlands (SFvdH, PJ, SEH, RJS, JWHK), the Department of Psychiatry, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands (SYI)
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Cayzac V, Bordes J, Valero B, Voisin H, Sagnard M, Bertin J, David T, El Chehab H. Cataract surgery without preanesthetic consultation: A 2-year retrospective study. J Fr Ophtalmol 2025; 48:104428. [PMID: 39933286 DOI: 10.1016/j.jfo.2025.104428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 07/05/2024] [Accepted: 09/24/2024] [Indexed: 02/13/2025]
Abstract
PURPOSE Cataract surgery is the most commonly performed procedure in the world. However, certain perioperative modalities remain controversial, and the necessity of systematic performance of a preanesthetic consultation is gradually being questioned. The goal of this study was to investigate the anesthetic and surgical safety of performing cataract surgeries under topical or sub-Tenon's anesthesia without prior preanesthetic consultation. METHODS Thus, we conducted a retrospective study at Sainte-Anne Military Teaching Hospital (Toulon, France) over the period from January 1, 2021, to December 31, 2022, including all patients admitted to the operating room for a phacoemulsification procedure performed under topical or sub-Tenon's anesthesia without prior preanesthetic consultation. Patients were referred to this simplified care pathway in the absence of: predictable surgical difficulties, significant anxiety, risk of agitation or claustrophobia, communication difficulties, lack of cooperation, difficulties in maintaining a motionless supine position, coughing or severe dyspnea or severe allergic history. The eligible patients for this care pathway were selected by the surgeon based on a list of indications. The occurrence of systemic or surgical complications, drug interventions, calls to the anesthesiologist, or unplanned hospitalization in the immediate postoperative period was recorded. RESULTS One thousand procedures were performed on 654 patients. No major systemic complications were recorded. Surgical complications occurred in 27 procedures (2.7%). Medication was administered to the patient intraoperatively during 413 (41.3%) procedures, mostly antihypertensive drugs (33.1%) and sedatives (11.5%). Aside from drug prescription, 9 calls (0.9%) were made to the anesthesiologist. There were no unplanned hospitalizations in the immediate postoperative period. CONCLUSION In our series, performing phacoemulsification procedures under topical or sub-Tenon's anesthesia without prior preanesthetic consultation has shown anesthetic and surgical complication rates comparable to those reported in the literature. Prospective comparative studies are needed to confirm the non-inferiority of this care pathway and to generalize its practice.
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Affiliation(s)
- V Cayzac
- Department of Ophthalmology, Sainte-Anne Military Hospital, 2, boulevard Sainte-Anne, BP 600, 83000 Toulon, France.
| | - J Bordes
- Department of Anesthesia, Sainte-Anne Military Hospital, 2, boulevard Sainte-Anne, BP 600, 83000 Toulon, France; French Military Health Service Academy of Val-de-Grâce, 74, boulevard de Port-Royal, 75005 Paris, France
| | - B Valero
- Department of Ophthalmology, Sainte-Anne Military Hospital, 2, boulevard Sainte-Anne, BP 600, 83000 Toulon, France
| | - H Voisin
- Department of Ophthalmology, Sainte-Anne Military Hospital, 2, boulevard Sainte-Anne, BP 600, 83000 Toulon, France
| | - M Sagnard
- Department of Ophthalmology, Sainte-Anne Military Hospital, 2, boulevard Sainte-Anne, BP 600, 83000 Toulon, France
| | - J Bertin
- Department of Ophthalmology, Sainte-Anne Military Hospital, 2, boulevard Sainte-Anne, BP 600, 83000 Toulon, France
| | - T David
- Department of Ophthalmology, Hôpital Nord, Aix-Marseille University, chemin des Bourrely, 13015 Marseille, France
| | - H El Chehab
- Department of Ophthalmology, Sainte-Anne Military Hospital, 2, boulevard Sainte-Anne, BP 600, 83000 Toulon, France; French Military Health Service Academy of Val-de-Grâce, 74, boulevard de Port-Royal, 75005 Paris, France
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Ferrara M, Romano V, Longo L, Rovati M, Raimondi R, Semeraro F, Aliberti S, Romano MR. Life-threatening complications in ophthalmic surgery: a systematic review. Eye (Lond) 2025; 39:69-78. [PMID: 39580602 PMCID: PMC11733002 DOI: 10.1038/s41433-024-03442-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 08/03/2024] [Accepted: 10/22/2024] [Indexed: 11/25/2024] Open
Abstract
Ophthalmic surgical procedures are widely acknowledged for their safety and efficacy. Undoubtedly, advances in ophthalmic surgery, along with the improvement of anaesthetic techniques, have contributed to the reduction in the occurrence of these events. However, although uncommon, systemic severe and life-threatening adverse events can still occur and it is imperative for an ophthalmologic surgeon to have a comprehensive understanding of them to act in terms of proactive prevention, prompt recognition, and optimal treatment, thus maximizing patients' outcomes. Among life-threatening complication following ophthalmic surgery, cardiovascular events represent the most common ones, including a range of different clinical entities: the oculocardiac reflex, potentially leading to haemodynamic instability and asystole; iatrogenic vascular air embolism, in form of venous air embolism or "pefluorocarbon syndrome", which can lead to obstruction of the pulmonary circulation, respiratory distress and cardiovascular collapse; postoperative venous thromboembolism, in the context of which the management of perioperative antiplatelet and anticoagulant therapy has a crucial role. Furthermore, among infectious complications, that are more commonly limited to the ocular tissues, necrotizing fasciitis represents a potentially lethal infection. This review aims to provide an up-to-date, evidence-based overview of potential life-threatening complications associated with ophthalmic surgery, exploring pathogenesis, risk factors, signs, symptoms, and, briefly, management strategies.
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Affiliation(s)
- Mariantonia Ferrara
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
- Eye Unit, ASST Spedali Civili di Brescia, Brescia, Italy
- School of Medicine, University of Malaga, Malaga, Spain
| | - Vito Romano
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
- Eye Unit, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Laura Longo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Marco Rovati
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Raffaele Raimondi
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle Upon Tyne, UK
| | - Francesco Semeraro
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
- Eye Unit, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Stefano Aliberti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Respiratory Unit, Milan, Italy
| | - Mario R Romano
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.
- Department of Ophthalmology, Humanitas Gavazzeni-Castelli, Bergamo, Italy.
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Doherty JU, Daugherty SL, Kort S, London MJ, Mehran R, Merli GJ, Schoenhagen P, Soman P, Starling RC, Johnson DM, Dehmer GJ, Schoenhagen P, Johnson DM, Bhave NM, Biederman RW, Bittencourt MS, Burroughs MS, Doukky R, Hays AG, Indik JH, Kim KM, Lotfi AS, Macchiavelli AJ, Neuburger P, Patel H, Pellikka PA, Reece TB, Rong LQ. ACC/AHA/ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2024 Appropriate Use Criteria for Multimodality Imaging in Cardiovascular Evaluation of Patients Undergoing Nonemergent, Noncardiac Surgery. J Am Coll Cardiol 2024; 84:1455-1491. [PMID: 39207318 DOI: 10.1016/j.jacc.2024.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
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Quecedo Gutierrez L, Alsina E, Del Blanco Narciso B, Vazquez Lima A, Zaballos Garcia M, Abad Gurumeta A. Pre-anaesthesia assessment in cataract surgery: Recommendations from the SEDAR Working Group. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024; 71:403-411. [PMID: 38428679 DOI: 10.1016/j.redare.2024.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
INTRODUCTION AND OBJECTIVES Cataract surgery is one of the most common procedures in outpatient surgery units. The use of information and communication technologies (ICT) in clinical practice and the advent of new health scenarios, such as the Covid pandemic, have driven the development of pre-anaesthesia assessment models that free up resources to improve access to cataract surgery without sacrificing patient safety. The approach to cataract surgery varies considerably among public, subsidised and private hospitals. This raises the need for guidelines to standardise patient assessment, pre-operative tests, management of background medication, patient information and informed consent. RESULTS In this document, the SEDAR Clinical Management Division together with the Major Outpatient Surgery Division SEDAR Working Group put forward a series of consensus recommendations on pre-anaesthesia testing based on the use of ITCs, health questionnaires, patient information and informed consent supervised and evaluated by an anaesthesiologist. CONCLUSIONS This consensus document will effectivise pre-anaesthesia assessment in cataract surgery while maintaining the highest standards of quality, safety and legality.
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Affiliation(s)
- L Quecedo Gutierrez
- Servicio de Anestesia, Hospital Universitario de La Princesa, Madrid, Spain.
| | - E Alsina
- Servicio de Anestesia, Hospital Universitario La Paz, Madrid, Spain
| | | | - A Vazquez Lima
- Servicio de Anestesia, Hospital Rivera Povisa, Pontevedra, Spain
| | - M Zaballos Garcia
- Servicio de Anestesia, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - A Abad Gurumeta
- Servicio de Anestesia, Hospital Universitario Infanta Leonor, Madrid, Spain
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Cheng SY, Wu YF, Gu XW, Zhao Q, Meng LH, Chen YX, Zhao XY. The incidence, risk factors, management and prognosis of postoperative systemic complications after ophthalmic surgery: a retrospective study at a tertiary, academic referral hospital over a decade. Ann Med 2023; 55:2262502. [PMID: 37796532 PMCID: PMC10557541 DOI: 10.1080/07853890.2023.2262502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/17/2023] [Indexed: 10/06/2023] Open
Abstract
PURPOSE To explore the incidence, risk factors, management and prognosis of systemic complications after ophthalmic surgeries. METHODS A retrospective review of hospitalized patients undergoing ophthalmic surgeries between 2012 and 2022 at Peking Union Medical College Hospital was performed to summarize and analyse the postoperative systemic complications. Multivariate logistic and linear regression analyses were conducted to clarify the risk factors of postoperative systemic complications and factors associated with the severity of adverse events. RESULTS A total of 34,841 patients underwent inpatient ophthalmic surgery, among which 162 systemic complications occurred in 150 patients during postoperative hospitalization. The overall incidence rate was 0.4%, with cardiovascular events (48.1%), digestive events (13.6%) and fever (12.3%) being the leading causes. About 17.3% of the cases had conditions improved after observation, 19.1% after symptomatic treatment, 54.9% had consultation with specific intervention and 8.6% were transferred to the corresponding departments for specialized treatment. For the prognosis, 93.8% had condition improved, 5.6% chose voluntary discharge without improvement, and one patient died of respiratory failure caused by postoperative pulmonary infection. The worse ADL (activities of daily living) grading, indication of primary intraocular lymphoma or intraocular tumour, surgery of simple pars plana vitrectomy (PPV), PPV with silicone oil tamponade, PPV with gas tamponade, general anaesthesia, history of diabetes mellitus (DM), chronic heart failure and digestive system disease were the risk factors positively correlated with postoperative systemic complications (p < .05). The worse ADL grading, history of DM and respiratory system disease were also positively correlated with the severity of the adverse events (p < .05). CONCLUSIONS The incidence of postoperative systemic complications was low among patients undergoing ophthalmic surgery, most were mild and could be relieved after observation, symptomatic or specialist consultation. Patients with worse ADL and history of DM should be paid extra attention.
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Affiliation(s)
- Shi-yu Cheng
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yan-fang Wu
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xing-wang Gu
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Qing Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Li-hui Meng
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - You-xin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xin-yu Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Metz AK, Berlin NL, Yost ML, Cheng B, Kerr E, Nathan H, Cuttitta A, Henderson J, Dossett LA. Comprehensive History and Physicals are Common Before Low-Risk Surgery and Associated With Preoperative Test Overuse. J Surg Res 2023; 283:93-101. [PMID: 36399802 DOI: 10.1016/j.jss.2022.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 09/21/2022] [Accepted: 10/16/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The Centers for Medicare and Medicaid Services (CMS) recently eliminated the requirement for preoperative history and physicals (H&Ps) prior to ambulatory surgery. We sought to assess variations in separately billed preoperative H&P utilization prior to low-risk ambulatory surgery, describe any relationship with preoperative testing, and identify independent predictors of these consultations prior to this policy change to help characterize the potential unnecessary utilization of these consultations and potential unnecessary preoperative testing prior to low-risk surgery. MATERIALS AND METHODS A retrospective cohort study was performed using claims data from a hospital value collaborative in Michigan from January 2015 to June 2019 and included patients undergoing one of three ambulatory procedures: breast lumpectomy, laparoscopic cholecystectomy, and laparoscopic inguinal hernia repair. Rates of preoperative H&P visits within 30 d of surgical procedure were determined. H&P and preoperative testing associations were explored, and patient-level, practice-level, and hospital-level determinants of utilization were assessed with regression models. Risk and reliability-adjusted caterpillar plots were generated to demonstrate hospital-level variations in utilization. RESULTS 50,775 patients were included with 50.5% having a preoperative H&P visit, with these visits being more common for patients with increased comorbidities (1.9 ± 2.2 vs 1.4 ± 1.9; P < 0.0001). Preoperative testing was associated with H&P visits (57.2% vs 41.4%; P < 0.0001). After adjusting for patient case-mix and interhospital and intrahospital variations in H&P visits, utilization remained with significant associations in patients with increased comorbidities. CONCLUSIONS Preoperative H&P visits were common before three low-risk ambulatory surgical procedures across Michigan and were associated with higher rates of low-value preoperative testing, suggesting that preoperative H&P visits may create clinical momentum leading to unnecessary testing. These findings will inform strategies to tailor preoperative care before low-risk surgical procedures and may lead to reduced utilization of low-value preoperative testing.
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Affiliation(s)
- Allan K Metz
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Nicholas L Berlin
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan; National Clinician Scholars Program, University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan
| | - Monica L Yost
- Michigan Value Collaborative, University of Michigan, Ann Arbor, Michigan
| | - Bonnie Cheng
- Michigan Value Collaborative, University of Michigan, Ann Arbor, Michigan
| | - Eve Kerr
- Michigan Program on Value Enhancement, Ann Arbor, Michigan; VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan; Department of Internal Medicine and Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Hari Nathan
- National Clinician Scholars Program, University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan; Michigan Value Collaborative, University of Michigan, Ann Arbor, Michigan; Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Anthony Cuttitta
- Michigan Program on Value Enhancement, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - James Henderson
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Lesly A Dossett
- Michigan Program on Value Enhancement, Ann Arbor, Michigan; Department of Surgery, University of Michigan, Ann Arbor, Michigan.
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Hanna V, Popovic MM, El-Defrawy S, Schlenker MB, Alaei R, Kertes PJ. Preoperative evaluations for ophthalmic surgery: A systematic review of 48,869 eyes. Surv Ophthalmol 2022; 68:526-538. [PMID: 36572226 DOI: 10.1016/j.survophthal.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 12/17/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022]
Abstract
Eliminating low-yield testing can reduce the burden on modern health care systems. Our purpose is to determine whether routine preoperative assessment impacts the incidence of perioperative complications in ophthalmic surgery. We conducted a comprehensive search of Ovid MEDLINE, EMBASE, and Cochrane Library databases to identify studies investigating the incidence of perioperative complications following any preoperative assessment for patients undergoing ophthalmic surgery (PROSPERO ID#164008). Four randomized controlled trials (RCTs) and 5 observational studies were selected for inclusion. Risk of bias assessment revealed a lack of masking and insufficient statistical power in RCTs, and confounding in observational studies. Routine preoperative testing-including laboratory tests, electrocardiogram, and imaging studiesdid not decrease the incidence of adverse events or risk of perioperative ocular and systemic complications in most studies. Two cohort studies (1 retrospective, 1 prospective) suggestd that patients with certain preexisting health conditions were at increased risk for adverse events perioperatively. Another retrospective study found a lower risk of complications in high-risk patients who underwent evaluation. While patients with comorbidities may be at increased risk of adverse events, the role of preoperative assessment is not well delineated in this population. Further study is required to determine the comparative safety, effectiveness, and implementation of alternative assessment tools.
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Affiliation(s)
- Verina Hanna
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Marko M Popovic
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Sherif El-Defrawy
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology, Kensington Eye Institute, Toronto, Ontario, Canada
| | - Matthew B Schlenker
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology, Kensington Eye Institute, Toronto, Ontario, Canada
| | - Ravin Alaei
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Peter J Kertes
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Ontario, Canada; John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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Fostier M, Januleviciute G, Fauconnier F, Collard E, Dubois V. Life-threatening hypotension in the immediate postoperative period of cataract surgery under topical anesthesia: a report of two cases. BMC Anesthesiol 2022; 22:345. [PMID: 36368969 PMCID: PMC9650168 DOI: 10.1186/s12871-022-01894-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 10/29/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cataract surgery is one of the most frequent surgeries in the world. It is a very safe procedure mostly performed under topical anesthesia in outpatients centers. Due to the growing lack of anesthesiologists, cataract surgeries are more frequently performed without an anesthesiologist present in the operating room. Although extremely rare, life-threatening complications may occur.
Cases presentation
We report two cases of cataract surgery complicated by severe hypotension that required emergency resuscitation in the immediate postoperative period and hospitalization in intensive care unit. Anaphylactic shock was confirmed in the first case and suspected in the second.
Conclusions and importance
Even though cataract surgery is a very safe procedure, it is essential to ensure the presence of an anesthesiologist to manage potential, though extremely rare, life-threatening complications such as anaphylactic reactions.
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The Influence of Inflammation in Posterior Capsule Opacification Development. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2022. [DOI: 10.2478/sjecr-2021-0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Cataract represents the reduction of the transparency of the crystalline lens. Cataract surgery is the most commonly performed surgical procedure worldwide. One of the most common postoperative complication of successfully performed cataract surgery is a development of posterior capsule opacification (PCO). In the postoperative period, lens epithelial cells (LECs) undergo proliferation, migration and differentiation, which is clinically manifested by the development of PCO. Inflammation has a central role in these processes. Cytokines, such as transforming growth factor β, fibroblast growth factor, interleukin 1, interleukin 6, matrix metalloproteinases have a huge effect on the activity of LECs. Understanding these processes can find a great usage in clinical practice. By prescribing anti-inflammatory therapy in the early postoperative period, the incidence of PCO can be significantly reduced.
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Cuttitta A, Joseph SS, Henderson J, Portney DS, Keedy JM, Benedict WL, Lahti H, Klarr PS, Shtein RM, Lee PP, Kerr E, Mian SI. Feasibility of a Risk-Based Approach to Cataract Surgery Preoperative Medical Evaluation. JAMA Ophthalmol 2021; 139:1309-1312. [PMID: 34709365 DOI: 10.1001/jamaophthalmol.2021.4393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance In 2019, the US Centers for Medicare & Medicaid Services implemented the Patients Over Paperwork initiative, allowing hospitals and ambulatory surgery centers to establish their own policies on preoperative history and physical requirements. A risk-based approach to preoperative medical evaluation may allow surgeons to provide high-value patient care. Objective To assess the feasibility of a risk-based approach to cataract surgery preoperative medical evaluation through a lens of safety and throughput. Design, Setting, and Participants A pilot study was performed to evaluate the implementation of a risk-based approach to preoperative medical evaluation for cataract surgery using a virtual medical history questionnaire. The intervention group, seen from June to September 2020, received the risk assessment and those who were low risk proceeded to surgery without further preoperative evaluation prior to the day of surgery. The preintervention control group included patients who received standard care from January to December 2019. Main Outcomes and Measures Primary outcomes included rates of intraoperative complications, noneye-related emergency department visits within 7 days, inpatient admissions within 7 days of surgery, case delays, and rates of case cancellation. The secondary outcome included patient perception regarding preoperative care. Results A total of 1095 patients undergoing cataract surgery were included in the intervention group (1813 [58.2%] female) and 3114 were in the control group (621/1095 [56.7%] female). The mean (SD) age was 68.6 (11.0) in the control group and 68.4 (10.5) in the intervention group. The intervention group included 126 low-risk individuals (11.5%) and 969 individuals who received standard care (88.5%). There were no differences between the control and intervention groups in terms of rates of intraoperative complications (control group vs intervention group: 21 [0.7%] vs 3 [0.3%]; difference, -0.4% [95% CI, -0.82 to 0.02]), 7-day noneye-related ED visits (5 [0.2%] vs 3 [0.3%]; difference, 0.1% [95% CI, -0.23 to 0.45]), 7-day inpatient admissions (6 [0.2%] vs 2 [0.2%]; difference, -0.01% [95% CI, -0.31 to 0.29]), or same-day cancellations (31 [0.8%] vs 10 [0.6%]; difference, -0.15% [95% CI, -0.63 to 0.34]). The control group had more case delays (59 [1.9%] vs 7 [0.6%]; difference, -1.3% [95% CI, -1.93 to -0.58]). Conclusions and Relevance This study suggests that a virtual, risk-based approach to preoperative medical evaluations for cataract surgery is associated with safe and efficient outcomes. These findings may encourage health care systems and ambulatory surgery centers to tailor preoperative requirements for low-risk surgery patients.
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Affiliation(s)
- Anthony Cuttitta
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan Health, Ann Arbor.,Michigan Program on Value Enhancement (MPrOVE), University of Michigan Health, Ann Arbor
| | - Shannon S Joseph
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan Health, Ann Arbor
| | - James Henderson
- Michigan Program on Value Enhancement (MPrOVE), University of Michigan Health, Ann Arbor.,Quality Department, University of Michigan Health, Ann Arbor.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - David S Portney
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan Health, Ann Arbor
| | - Jenna M Keedy
- Michigan Program on Value Enhancement (MPrOVE), University of Michigan Health, Ann Arbor.,Quality Department, University of Michigan Health, Ann Arbor
| | - Wendy L Benedict
- Michigan Program on Value Enhancement (MPrOVE), University of Michigan Health, Ann Arbor.,Quality Department, University of Michigan Health, Ann Arbor
| | - Hannah Lahti
- Michigan Program on Value Enhancement (MPrOVE), University of Michigan Health, Ann Arbor.,Quality Department, University of Michigan Health, Ann Arbor
| | - Pattricia S Klarr
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor
| | - Roni M Shtein
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan Health, Ann Arbor.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Paul P Lee
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan Health, Ann Arbor.,Michigan Program on Value Enhancement (MPrOVE), University of Michigan Health, Ann Arbor.,Quality Department, University of Michigan Health, Ann Arbor.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Eve Kerr
- Michigan Program on Value Enhancement (MPrOVE), University of Michigan Health, Ann Arbor.,Quality Department, University of Michigan Health, Ann Arbor.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Shahzad I Mian
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan Health, Ann Arbor
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12
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Duroi Q, Baudet JM, Bigoteau M, Slim M, Pichard T, Pisella PJ, Khanna RK. Ambulatory cataract surgery centre without perioperative anaesthesia care: a prospective cohort study. Sci Rep 2021; 11:8311. [PMID: 33859328 PMCID: PMC8050067 DOI: 10.1038/s41598-021-87926-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/22/2021] [Indexed: 11/25/2022] Open
Abstract
This study aims to evaluate the safety and patient satisfaction of a fast-track procedure for cataract surgery under topical anaesthesia without perioperative anaesthesia care. This is a prospective single-centre study including all cataract procedures in the Centre Ambulatoire de la Chirurgie de la Cataracte at the Hospital of Bourges between May and August 2018. Procedures were performed under topical anaesthesia without the presence of a nurse anaesthesiologist or anaesthesiologist, the patient had not fasted, and no peripheral venous line was placed. Only heart rate and oxygen saturation were monitored intraoperatively with pulse oximetry. Incidence and nature of intraoperative adverse events and surgical complications were recorded. Patient satisfaction was assessed using the Iowa Satisfaction with Anaesthesia Scale (ISAS). In total, 651 cataract surgeries were performed among which 614 (94.3%) were uneventful. Thirty (4.6%) intraoperative adverse events and 8 (1.2%) surgical complications were recorded. All surgeries were successfully completed. No medical emergency team intervention or hospital admittance was encountered. The mean ISAS score was 5.7/6, indicating high patient satisfaction. Cataract surgery in an ambulatory cataract surgery centre without perioperative anaesthesia care is a safe procedure with high patient satisfaction for screened patients. Anaesthesia ressources are scarce and may be more beneficial to more complex ophthalmic or non-ophthalmic surgeries.
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Affiliation(s)
- Quentin Duroi
- Department of Ophthalmology, Centre Hospitalier Universitaire Régional de Bretonneau, Bretonneau University Hospital of Tours, 2 Boulevard Tonnellé, 37000, Tours, France.,Department of Ophthalmology, Centre Hospitalier Jacques Coeur, Bourges, France
| | - Jean-Marie Baudet
- Department of Ophthalmology, Centre Hospitalier Jacques Coeur, Bourges, France
| | - Maxime Bigoteau
- Department of Ophthalmology, Centre Hospitalier Universitaire Régional de Bretonneau, Bretonneau University Hospital of Tours, 2 Boulevard Tonnellé, 37000, Tours, France.,Department of Ophthalmology, Centre Hospitalier Jacques Coeur, Bourges, France
| | - Malek Slim
- Department of Ophthalmology, Centre Hospitalier Jacques Coeur, Bourges, France
| | - Tiphanie Pichard
- Department of Ophthalmology, Centre Hospitalier Jacques Coeur, Bourges, France
| | - Pierre-Jean Pisella
- Department of Ophthalmology, Centre Hospitalier Universitaire Régional de Bretonneau, Bretonneau University Hospital of Tours, 2 Boulevard Tonnellé, 37000, Tours, France
| | - Raoul Kanav Khanna
- Department of Ophthalmology, Centre Hospitalier Universitaire Régional de Bretonneau, Bretonneau University Hospital of Tours, 2 Boulevard Tonnellé, 37000, Tours, France. .,INSERM 1253 iBrain «Neurogénomique & Physiopathologie neuronale», Tours, France.
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13
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Rossi T, Romano MR, Iannetta D, Romano V, Gualdi L, D'Agostino I, Ripandelli G. Cataract surgery practice patterns worldwide: a survey. BMJ Open Ophthalmol 2021; 6:e000464. [PMID: 33501377 PMCID: PMC7812090 DOI: 10.1136/bmjophth-2020-000464] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 11/15/2020] [Accepted: 12/03/2020] [Indexed: 11/24/2022] Open
Abstract
Objective To report the results of a global survey on cataract practice patterns related to preoperative, intraoperative and postoperative care, surgical setting and personnel allocation. Methods and analysis An online 28 questions survey was sent to 240 ophthalmologists asking to describe prevailing trends in their institutions across 38 countries and 5 continents. Questions inquired country, institution, surgical volume and setting, anaesthesia, preoperative and intraoperative examination and postsurgical care. Statistical analysis used crosstabs lambda statistics for non-parametric nominal variables. P value less than 0.05 was considered statistically significant. Results 209/240 (87%) ophthalmologists responded: 38% representing public hospitals, 36% private practices and 26% academic sites; overall surgical volume was between 241 700 and 410 500 cataracts per year. There was a significant correlation between type of institution and surgical volume. Complete results available in online (https://freeonlinesurveys.com/r/W6BcLLxy). Conclusion Cataract surgery related patterns of perioperative care showed significant difference among respondents, regardless to type of institution, surgical volume and country. Many evidence-based procedures are unevenly practiced around the world and some widespread and expensive habits lack solid scientific evidence while consuming enormous amount of resources both monetary and human. There is a need to reach consensus and share evidence-based practice patterns.
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Affiliation(s)
- Tommaso Rossi
- Ophthalmology, Ospedale Policlinico San Martino Istituto di Ricovero e Cura a Carattere Scientifico per l'Oncologia, Genova, Italy
| | - Mario R Romano
- Department of Health Sciences, Humanitas University, Milan, Italy
| | - Danilo Iannetta
- Ophthalmology, Arcispedale Santa Maria Nuova di Reggio Emilia, Reggio Emilia, Italy
| | - Vito Romano
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | | | - Isabella D'Agostino
- Ophthalmology, Ospedale Policlinico San Martino Istituto di Ricovero e Cura a Carattere Scientifico per l'Oncologia, Genova, Italy
| | - Guido Ripandelli
- IRCSS Fondazione G B Bietti per lo Studio e la Ricerca in Oftalmologia ONLUS, Roma, Italy
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14
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The prevalence of preoperative medical testing and consultation in cataract surgery patients at a teaching hospital. J Cataract Refract Surg 2020; 46:827-830. [PMID: 32347690 DOI: 10.1097/j.jcrs.0000000000000153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the prevalence of preoperative cataract surgery testing and consultation at a single United States teaching hospital. SETTING Academic-affiliated Veterans Affairs Medical Center. DESIGN Retrospective chart review. METHODS This study included patients who received cataract surgery from 2014 to 2018. For patients with bilateral cataracts, the second surgery was excluded to ensure independent selection. Charlson Comorbidity Index (CCI) scores and heart disease status were recorded. The outcomes of interest were preoperative testing, such as complete blood count, chemistry panel, and echocardiography, and consultation (office visits to non-ophthalmologists) during the period between the date the decision was made to proceed with surgery and the cataract surgery date. RESULTS For this study 1320 charts were reviewed; 1257 (95.2%) patients met the study criteria. The mean CCI score was 1.7; 42.0% (528/1257) had heart disease. The prevalence of preoperative testing was 0.08% (1/1257). The prevalence of preoperative consultation was 4.2% (53/1257); 86.8% (46/53) of patients received cardiology consultation; 17.0% (9/53) pulmonology; and 15.1% (8/53) primary care. Of the patients who received cardiac consultation, 63.0% (29/46) had heart disease; the remaining had an electrocardiogram abnormality. CONCLUSIONS There was a low prevalence of preoperative testing and consultation for cataract surgery at this teaching hospital. Further studies using medical record data are needed to assess the current rates and the role of preoperative testing and consultation for cataract surgery patients.
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15
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medghalchi A, Akbari M, Soltani Moghadam R, Alizadeh Y. Predictors of Patient Cooperation during Phacoemulsification Surgery under Topical Anesthesia. CASPIAN JOURNAL OF HEALTH RESEARCH 2019. [DOI: 10.29252/cjhr.4.4.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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16
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Benoit A, Bellan L, Wallace M, Toth G, Djukic RR, Ginter-Boyce B, Girling L, Dekeyster C, Mutter TC. Does eliminating the preoperative history and physical make a difference in low-risk cataract surgery patients? A before and after study of 30-day morbidity and mortality. Can J Ophthalmol 2019; 54:529-539. [PMID: 31564341 DOI: 10.1016/j.jcjo.2018.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 12/05/2018] [Accepted: 12/07/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the safety of omitting the conventional preoperative history and physical examination (H&P) for low-risk cataract surgery patients. DESIGN Comparison of outcomes before and after the January 1, 2015 system wide implementation of a program that eliminated the conventional preoperative H&P for low-risk patients as identified by a 12-item risk stratification questionnaire. PARTICIPANTS Two separate groups of Winnipeg residents who had cataract surgery at the city's sole ophthalmological referral centre between July 1 and December 31, 2014 (preimplementation reference group) or between October 1, 2015 and March 31, 2016 (postimplementation intervention group). METHODS A detailed chart review was completed for cataract surgery patients who experienced a postoperative medical event (a composite of death or hospital admission or emergency department visit, identified within administrative databases) within 30 days of surgery. Nonfatal events were captured for all 7 hospitals and urgent care centres in the city, including the ophthalmological referral centre. RESULTS Postoperative medical events occurred in 114 of 2981 (3.82%) intervention group surgeries and 125 of 3037 (4.12%) reference group surgeries (Relative risk 0.92, 95% confidence interval 0.72 to 1.19, p = 0.6 Fisher exact test). Subgroup analyses of major medical events and medical events by affected organ system yielded no significant differences between the 2 groups. In the opinion of the physician chart reviewers, none of the events among low-risk patients in the intervention group were related to the omission of a conventional preoperative H&P. CONCLUSIONS The risk of adverse medical events within 30 days of cataract surgery was not higher after the omission of the conventional preoperative H&P in patients screened to be low risk by a validated preoperative questionnaire.
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Affiliation(s)
- Archie Benoit
- Departments of Anaesthesia and Perioperative Medicine - Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.
| | - Lorne Bellan
- Ophthalmology - Max Rady College of Medicine, University of Manitoba, Winnipeg, Man
| | - Marc Wallace
- Department of Community Health Sciences - Max Rady College of Medicine, University of Manitoba, Winnipeg, Man
| | - Gillian Toth
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, Man
| | | | | | - Linda Girling
- Departments of Anaesthesia and Perioperative Medicine - Max Rady College of Medicine, University of Manitoba, Winnipeg, Man
| | | | - Thomas C Mutter
- Departments of Anaesthesia and Perioperative Medicine - Max Rady College of Medicine, University of Manitoba, Winnipeg, Man
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Gabbay IE, Gabbay U, Goldstein DA, Nahum Y. Should every candidate for cataract extraction be scheduled to the preoperative clinic? The Rabin Medical Center experience. Eur J Ophthalmol 2019; 30:1268-1271. [PMID: 31353952 DOI: 10.1177/1120672119865842] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cataract surgery is one of the most common elective surgeries. We present a novel approach of preoperative triage using community-based ophthalmologist referral letters for scheduling surgery, thus reducing both patient and physician time prior to surgery. Since most patients are not routinely examined in a preoperative clinic, day of surgery cancelations are a possibility. The aim of this study is to evaluate the efficiency of our triage system. METHODS Historical prospective study in which the end point was day-of-surgery cancelation. The main outcome measure of this study was the rate of cancelations which could have been prevented by a preoperative visit. Patients' records were reviewed for reasons for cancelation and demographics. RESULTS During the study period, 1030 patients underwent cataract surgery, 171 patients (16.6%) were examined in the preoperative clinic. Forty-five patients (4.4%) were canceled on the day of surgery due to various reasons. The main reason for cancelation (13 cases, 28.9%) was non-availability of operating theater. In 20 cases (1.9% of total patients, 44.4% of cancelations), the cancelations could have been prevented by a preoperative clinic visit. CONCLUSION Our results suggests that most cataract patients do not require preoperative visit prior to the day of surgery. The cooperation of community-based ophthalmologists and the availability of senior surgeons in the operating theater allows for the proper implementation of our system. Direct referral to surgery could shorten both costs and time to surgery and provide timely treatment for cataracts in a cost-aware environment.
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Affiliation(s)
- Itay Elimelech Gabbay
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Gabbay
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Quality Assurance and Risk Management, Rabin Medical Center, Petach Tikva, Israel
| | - Daniel A Goldstein
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Davidoff Cancer Center, Rabin Medical Center, Petach Tikvah, Israel.,Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Yoav Nahum
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Karim HMR. Healthcare delivery cost and anesthesiologists: Time to have a greater role and responsibility. World J Anesthesiol 2019; 8:19-24. [DOI: 10.5313/wja.v8.i3.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 06/06/2019] [Accepted: 06/18/2019] [Indexed: 02/06/2023] Open
Affiliation(s)
- Habib Md Reazaul Karim
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Raipur 492099, India
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19
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Costa MCDBG, Furtado MV, Borges FK, Ziegelmann PK, Suzumura ÉA, Berwanger O, Devereaux PJ, Polanczyk CA. Perioperative Troponin Screening Identifies Patients at Higher Risk for Major Cardiovascular Events in Noncardiac Surgery. Curr Probl Cardiol 2019; 46:100429. [PMID: 31326099 DOI: 10.1016/j.cpcardiol.2019.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 05/29/2019] [Indexed: 01/30/2023]
Abstract
Myocardial injury after noncardiac surgery (MINS) includes patients with traditional myocardial infarction and those with ischemic myocardial injury after surgery. This study evaluated the prognostic value of MINS on major cardiovascular events and 30-day mortality, and determined independent preoperative predictors of MINS in patients after noncardiac surgery. This multicenter prospective cohort study was part of the VISION Study. The sample consisted of 2504 patients who underwent noncardiac surgery at 2 tertiary hospitals in Brazil between September 2008 and July 2012. Troponin Ts were measured 6-12 hours, and on days 1-3 after surgery. Cox regression analyses were performed to identify independent variables of major outcomes. A total of 314 (13%) patients were diagnosed with MINS, of which 26 (8%) died. Length-of-hospital stay of MINS patients was 3 times higher (18 ± 22 days vs 5.8 ± 11 days). In multivariate analysis, 30-day mortality was significantly higher among patients with MINS (hazard ratio [HR] 3.17 (95% confidence interval [CI] 1.56-6.41)), and major bleeding (HR 5.76 (95% CI 2.75-12.05)), sepsis (HR 5.08 (95% CI 2.25-11.46)), active cancer (HR 4.22 (95% CI 1.98-8.98)), and general surgery (HR 3.11 (95% CI 1.51-6.41)). Multivariable analysis indicated a higher chance of MINS in patients ≥75 years of age, history of diabetes mellitus, hypertension, heart failure, coronary disease, and end-stage renal failure. The incidence of MINS within 30 days after noncardiac surgery is related to higher mortality. Postoperative troponin monitoring in elder patients and with risk factors for atherosclerotic disease may help reduce postoperative cardiovascular events.
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20
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Schock K, Ragan A, Huang JT. Defunding preoperative histories and physical exams: putting the cart before the evidence? Can J Ophthalmol 2019; 54:171-175. [PMID: 30975339 DOI: 10.1016/j.jcjo.2018.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/25/2018] [Accepted: 04/03/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Several Canadian health authorities have defunded preoperative cataract history and physical examinations performed by general practitioners. While these authorities suggest that such decisions are evidence-based, we are unaware of reviews addressing this topic, nor have health authorities been forthcoming with evidence used in their decision-making processes. The objective of this study is to perform a comprehensive review of the literature regarding the value of preoperative histories and physical examinations in cataract surgery. DESIGN Systematic review. METHODS The following databases were searched: PubMed, MEDLINE, Cochrane Library, Google Scholar, Web of Science, EMBASE, CINAHL, and BIOSIS Previews. Only higher-level forms of evidence were assessed, including randomized controlled trials, cohort, and case-control studies. Two reviewers independently assessed titles and abstracts for concordance with inclusion criteria. Disagreements between authors were resolved by discussion. RESULTS We identified 3 articles that met our inclusion criteria: two prospective and one retrospective cohort studies. These articles suggest traditional preoperative histories and physical examinations could be replaced by a health questionnaire (Jastrzebski et al. and Reeves et al.) or eliminated altogether (Alboim et al.). DISCUSSION Scientific literature presently contains 3 studies suggesting that preoperative histories and physical examinations could be modified or eliminated. However, methodological weaknesses and data analysis derived from these studies suggests defunding preoperative medical examination may be premature. CONCLUSIONS While finding efficiencies in medical care is admirable, physicians should be cautious in accepting recommendations that reduce checks ensuring perioperative safety. Further studies of better methodological quality should be completed to clarify the present evidence.
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Affiliation(s)
- Kiersten Schock
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Alex Ragan
- Division of Ophthalmology, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - John T Huang
- Division of Ophthalmology, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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21
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Kumar CM, Seet E, Eke T, Joshi GP. Hypertension and cataract surgery under loco-regional anaesthesia: not to be ignored? Br J Anaesth 2017; 119:855-859. [PMID: 29028916 DOI: 10.1093/bja/aex247] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- C M Kumar
- Department of Anaesthesia, Khoo Teck Puat Hospital, Yishun Central 90, Singapore
| | - E Seet
- Department of Anaesthesia, Khoo Teck Puat Hospital, Yishun Central 90, Singapore
| | - T Eke
- Department of Ophthalmology, Norfolk and Norwich University Hospitals, Norwich, UK
| | - G P Joshi
- Department of Anaesthesia, University of Texas Southwestern Medical Center, Dallas, TX, USA
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22
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Azma T, Nishioka A. Are techniques for general anesthesia less invasive than procedures for cataract surgery? Eye (Lond) 2017; 31:1744-1745. [PMID: 28707674 DOI: 10.1038/eye.2017.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- T Azma
- Department of Anesthesiology and Pain Medicine, Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa, Chiba, Japan
| | - A Nishioka
- Department of Anesthesiology and Pain Medicine, Kohnodai Hospital, National Center for Global Health and Medicine, Ichikawa, Chiba, Japan
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23
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Wahr JA, Thomas JJ. Even a Child of Four Could Do It!a Maximizing Efficiency in a Preoperative Clinic Using the Patient-Centered Anesthesia Triage System. Anesth Analg 2017; 124:1758-1759. [DOI: 10.1213/ane.0000000000001954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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