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.