Jk. Tobacman et al., ASSESSMENT OF APPROPRIATENESS OF CATARACT-SURGERY AT 10 ACADEMIC MEDICAL-CENTERS IN 1990, Ophthalmology, 103(2), 1996, pp. 207-215
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.