Appropriateness of phacoemulsification in Spain

Abstract

Objective: To evaluate the appropriateness of phacoemulsification procedures performed in four Spanish regions, applying criteria developed by means of RAND/UCLA methodology.

Design: Prospective observational study.

Setting: Seventeen public teaching hospitals in four regions of Spain.

Participants: Patients on waiting list to undergo cataract extraction by phacoemulsification.

Intervention: Cataract surgery by phacoemulsification.

Main outcome measure: Level of appropriateness of each intervention, according to criteria developed by means of the RAND/UCLA appropriateness methodology.

Results: Among the 5442 analysed patients the indication of phacoemulsification was appropriate in 69.6%, inappropriate in 7.3% and uncertain in 23.0%. Presence of ocular comorbidity, lack of cataract-induced visual function limitation, anticipated postoperative visual acuity of <0.5, preoperative visual acuity of >0.1 and high surgical complexity were associated with inappropriateness.

Conclusions: Some clinical characteristics, when present, make it especially important to obtain a careful assessment of the risks and benefits of surgery. Consideration of these characteristics may improve the appropriateness of phacoemulsification.