Appropriateness of phacoemulsification in Spain
ABSTRACT To evaluate the appropriateness of phacoemulsification procedures performed in four Spanish regions, applying criteria developed by means of RAND/UCLA methodology.
Prospective observational study.
Seventeen public teaching hospitals in four regions of Spain.
Patients on waiting list to undergo cataract extraction by phacoemulsification.
Cataract surgery by phacoemulsification.
Level of appropriateness of each intervention, according to criteria developed by means of the RAND/UCLA appropriateness methodology.
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.
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.
- SourceAvailable from: Aura FalckActa ophthalmologica 09/2012; 90(8). DOI:10.1111/j.1755-3768.2012.02535.x · 2.51 Impact Factor
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ABSTRACT: OBJECTIVE: To estimate the incidence and characteristics of rhegmatogenous retinal detachment (RRD) in The Netherlands in 2009. DESIGN: Retrospective, observational case series. PARTICIPANTS: All patients with RRD in the Dutch population in 2009. METHODS: By reviewing surgical logs, cases of primary RRD repair in 2009 were identified. Exclusion criteria included RRD before 2009 and exudative, tractional, or traumatic retinal detachments. Patient demographics, date of surgery, and lens status were documented. Incidence of RRD and 95% confidence intervals (CIs) were calculated based on the Poisson distribution. Age distribution, male-to-female ratio, and proportion of RRD patients with prior cataract extraction (CE) were determined. A Student t test was used to examine differences in the incidence of RRD between groups. MAIN OUTCOME MEASURES: Annual RRD incidence in the population and per gender-adjusted age category and proportion of RRD patients with prior CE. RESULTS: The annual RRD incidence was 18.2 per 100 000 people (95% CI, 11.4-18.8), with a peak incidence of 52.5 per 100 000 people (95% CI, 29.4-56.8) between 55 and 59 years of age. The Bilateral RRD rate was 1.67%. Macula-off presentation occurred in 54.5% of all RRD patients. Prior CE was noted in 33.5% of RRD eyes. The male-to-female ratio was 1.3:1, and RRD incidence was statistically significantly more frequent in males (P<0.0001). CONCLUSIONS: Rhegmatogenous retinal detachment is predominantly a disease of the population older than 50 years, and males are more susceptible to RRD. The annual RRD incidence is highly dependent on demographic characteristics. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.Ophthalmology 12/2012; 120(3). DOI:10.1016/j.ophtha.2012.09.001 · 6.17 Impact Factor
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ABSTRACT: Cataract surgery rates have dramatically increased in the last two decades. However, clinical practice variation in cataract surgery has not been thoroughly studied. The aim of this review is to analyze clinical practice variation, including the causes and consequences of this phenomenon. Then, its role in health care planning and health care quality is focused, emphasizing the importance of reducing it and providing several practical strategies to accomplish it. The latest researches are presented in this article. They identify the development and implementation of clinical practice guidelines as the best tool to standardize care processes. Managing unwarranted or unwanted variation would improve quality of care and may lead to a significant saving in health care spending. Copyright © 2014 Sociedad Española de Oftalmología. Published by Elsevier Espana. All rights reserved.Archivos de la Sociedad Espanola de Oftalmologia 12/2014; 90(5). DOI:10.1016/j.oftal.2014.07.006