ASSESSMENT OF APPROPRIATENESS OF CATARACT-SURGERY AT 10 ACADEMIC MEDICAL-CENTERS IN 1990

Citation
Jk. Tobacman et al., ASSESSMENT OF APPROPRIATENESS OF CATARACT-SURGERY AT 10 ACADEMIC MEDICAL-CENTERS IN 1990, Ophthalmology, 103(2), 1996, pp. 207-215
Citations number
12
Categorie Soggetti
Ophthalmology
Journal title
ISSN journal
01616420
Volume
103
Issue
2
Year of publication
1996
Pages
207 - 215
Database
ISI
SICI code
0161-6420(1996)103:2<207:AOAOCA>2.0.ZU;2-K
Abstract
Purpose: To develop criteria for the appropriateness of cataract surge ry (extracapsular cataract extraction or phacoemulsification with plan ned implantation of a posterior chamber intraocular lens) and to apply these criteria to patients from ten academic medical centers. Methods : The study is a retrospective case series from ten academic medical c enters. One thousand one hundred thirty-nine patients who had had cata ract surgery in 1990 at the medical centers were selected randomly. Pa tients, identified by specific ICD-9-CM or CPT-4 codes, had no other o cular surgery performed at the same time as cataract surgery. Rates of inappropriate, uncertain, appropriate, and appropriate and crucial su rgeries were determined by application of the criteria established by a multidisciplinary expert panel. Results: Approximately 2% of the pro cedures were classified as inappropriate, after adjusting for missing or nonspecific visual function by use of discriminant analysis. Ninety -one percent of the procedures were classified as appropriate (52%) or appropriate and crucial (39%), Seven percent were designated as uncer tain, either due to a median rating in the uncertain range or to disag reement in ratings among the panelists. Significant variation occurred in the results among the different institutions: inappropriate surger ies ranged from 0% to 4%, uncertain from 1% to 14%, appropriate from 3 5% to 66%, and appropriate and crucial from 21% to 62% (P = 0.02). Con clusion: A small percentage of cataract surgeries was performed at the se ten academic medical centers for inappropriate indications using th e study criteria. Given the large number of cataract surgeries perform ed annually, the small percentage of uncertain and inappropriate surge ries may translate into a large number of surgeries performed for less than appropriate or appropriate and crucial indications. Significant variation existed among the institutions in the distribution of approp riate and crucial and appropriate compared with uncertain and inapprop riate surgeries.