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Criteria for postponement of day case cataract surgery under local anaesthesia: a cross sectional survey of UK ophthalmologists

Poster Details

First Author: M.Khan UK

Co Author(s):    S. Mangat   A. Negi           

Abstract Details

Purpose:

Cataract extraction is the commonest elective surgical procedure in the United Kingdom. Postponement of day case cataract surgery is a well recognised problem resulting in cost implications and patient inconvenience. The RCOphth/ RCA guidelines recommend ‘adequate’ pre-operative control of blood pressure (BP), blood sugar (BM) and coagulation (INR) without giving any specific values for these parameters. As a consequence, the decision making process with regards to postponement of day case cataract surgery remains largely anecdotal, subjective and variable. We devised a cross-sectional survey to explore the practice of cancellation, and factors which influence this, among UK Consultant Ophthalmologists.

Setting:

Solihull Hospital, Birmingham, United Kingdom.

Methods:

One hundred and thirty Consultant Ophthalmologists completed an anonymous e-questionnaire employed to assess variation in clinical practice in relation to cancellation of day case cataract surgery. This included questions exploring factors which would influence the decision to postpone such as presence of blepharitis, elevated BP and INR (including the individual clinicians’ threshold ranges) and how other variables, such as the method of local anaesthesia, influenced the final decision.

Results:

The median number of cataract surgeries performed by the respondents was three-to four hundred per year. The majority (74%) had been Consultant for less than 15 years. Most favoured topical anaesthesia (50.8%) followed by Sub-Tenons (43%), peribulbar (11.7%) and retrobulbar (1.6%). The majority of respondents would cancel surgery at systolic BP>190mmHg and a diastolic BP>100mmHg however a significant proportion using topical anaesthesia chose to ignore BP. The threshold for INR varied significantly and most would cancel if this was high. Those using topical anaesthesia were less likely to cancel for elevated BP when compared with those employing Sub-Tenons.

Conclusions:

This is the first study of its kind assessing the cancellation practice for day case cataract surgery among UK Consultant Ophthalmologists. Cancellation of surgery results in significant cost implications in addition to patient inconvenience. The current guidelines are vague and the practice of cancellation, as demonstrated by our study, is highly anecdotal and subjective. This reflects a lack of good evidence-base. Future studies are required to better instruct the most appropriate parameters for cancellation to be considered so that clearly defined guidelines can be instituted.

Financial Disclosure:

NONE

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