A new study published in JAMA Internal Medicine may allow ophthalmologists to skip routine anesthesiology during cataract surgery.
Eye Surgery
Cataract Surgery Patients
After examining Medicare claims for 36,652 patients who had cataract surgery in 2017, a team of UC San Francisco researchers concluded that for many cataract patients it may be reasonable to consider performing the procedure without routine anesthesia support.
Based on the data, the researchers discovered that the use of anesthesia care for cataract surgery was significantly higher when compared to patients undergoing other elective, low-risk outpatient procedures. These procedures include cardiac catheterization and colonoscopy screening.
They discovered that patients who underwent the other low-risk procedures had fewer systemic complications such as myocardial infarction or stroke. Even when anesthesiologists weren't present for the cataract surgery, the results were still accurate.
Anesthesia for Cataract Surgery
Catherine Chen, a senior study author and UCSF associate professor in Anesthesia and Perioperative Care, pointed out that they only looked at systemic complications and not ophthalmologic outcomes. She stated that they are evaluating those next but that it would be premature to change practice based on the study. She was hoping they could strike up a conversation.
Chen stated that an anesthetic and possibly sedation are required for cataract surgery. However, knowing who should be present for administration and intraoperative monitoring of these patients is an important question. Cataract surgery used to be associated with a much higher risk of complications, which helps to explain the historical and legacy use of anesthesiologists and/or certified registered nurse anesthetists.
According to News Medical, ophthalmologists have improved their technique over time so cataract surgery is now much safer and can be performed as an outpatient procedure. Often, a topical anesthetic, such as numbing drops in the eyeball, is all that is required. At UCSF, they use a small amount of fentanyl and midazolam, both of which can be safely administered by a sedation nurse.
Results and Findings of the Study
According to the study, 90% of Medicare patients who undergo cataract surgery have an anesthesia provider at their bedside. On the other hand, low-risk elective procedures have a range of <1% to 70% at the bedside. In contrast, patients undergoing cataract surgery experienced fewer systemic complications within seven days at 7.7% than patients undergoing other low-risk procedures at a range of 13% to 52%.
Around 6% of ophthalmologists never used anesthesia providers, 77% always used them, and 17% only used them for a subset of patients. Systemic complications occurred in 7.4% of ophthalmologists' patients who had never used anesthesia providers.
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Significance of Anesthesiologist in the Operating Room
According to Chen, professional associations provide no specific guidance on whether to include an anesthesia expert during cataract surgery. She said that other countries do not routinely use them, with no negative consequences.
With an increasing number of non-OR procedures, such as endoscopic or interventional radiology procedures, where patients are often much sicker and the procedure potentially more invasive, there aren't always enough of these specialists to go around, according to Chen.
Chen said that they are currently working on a study to see the impact of having an anesthesiologist in the OR. They want to know if the patients are calmer and possibly less likely to move, and so the ophthalmologic outcomes could be better.
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