hong kong eye hospital acknowledgement ot nursing staff mro staff unplanned av rate 2010-112
TRANSCRIPT
Hong Kong Eye HospitalHong Kong Eye Hospital
Acknowledgement
OT nursing staff MRO staff
Unplanned AV rate 2010-11 2
Introduction Importance of auditing cataract surgery
outcomesMost commonly performed surgery Surgeons at different levels of trainingThe Royal College of Ophthalmologists –
cataract surgery guidelines recommendations
Especially important this year with increase in cataract surgery load
Unplanned AV rate 2010-11 3
Posterior capsule rupture One of the most common adverse surgical
events Incidence varies from 0.7% to 16%* Acceptable range around 2-4% Associated with a poor visual outcome
Cystoid macular edemaRetinal detachment
Unplanned AV rate 2010-11 4Surv Ophth 2001
Methods Cataract surgeries performed in HKEH
between 1 April 2010 to 31 Jan 2011PhacoemulsificationExtracapsular cataract extraction
No of AV________
No of surgeries performed
Unplanned AV rate 2010-11 5
Mechanical vitrectomyPlanned AV excludedInformation from nursing recordConfirmed with patient recordBoth as surgeon and supervisor
Information from CDARSCombine surgery excluded
Primary outcome Unplanned AV rate
HospitalPhaco versus ECCESpecialist versus non-specialistIndividual surgeon
Individual surgeon information confidentialFeedback to surgeon
Unplanned AV rate 2010-11 6
Results Phacoemulsification
40 phaco surgeons4094 phaco60 unplanned AV casesRate 1.5%
ECCE35 ECCE surgeons650 ECCE18 unplanned AV casesRate 2.8%
Unplanned AV rate 2010-11 7
Comparison of results
2007/8 2009/10 2010/11
PhacoemulsificationAV rate (%)
1.9 2.0 1.5
ECCE AV rate (%) 4.1 2.6 2.8
Unplanned AV rate 2010-11 8
Specialist vs non-specialist
Unplanned AV rate 2010-11 9
Specialist Non-specialist Overall
PhacoemulsificationAV rate (%)
1.3 1.9 1.5
ECCE AV rate (%) 1.4 3.9 2.8
Unplanned AV rate 2010-11 10
Phacoemulsification
No serious outliers
Variation in surgical load
Unplanned AV rate 2010-11 11
ECCE
Lesser ECCELess surgical experienceSmaller denominator
Secondary outcomes Mean final visual outcomes Stage when PCR occurred Lens status Other major complications
Unplanned AV rate 2010-11 12
Final visual outcomes
Unplanned AV rate 2010-11 13
Mean Snellen VA (range)*
Phacoemulsification 0.40 (0.05-0.8)
ECCE 0.41 (0.1-0.7)
*Cases with other accountable cause of poor visual acuity excluded
Stage of phaco when PCR occurred
Unplanned AV rate 2010-11 14
More than half after nucleus removed
Lens status
Unplanned AV rate 2010-11 15
Aphakia (%) Pseudophakia
Sulcus (%) SFIOL (%) ACIOL (%)
Phacoemulsification 23 53 5 20
ECCE 47 20 0 33
Other complications
Phacoemulsification ECCE
Dropped nucleus 6 1
Retained cortical matter 7 1
Vitreous hemorrhage 5 3
Suprachoroidal hemorrhage 0 1 (limited)
Choroidal detachment 2 0
Retinal break 4 0
Retinal detachment 1 0
Unplanned AV rate 2010-11 16
Conclusions
Unplanned AV rates of cataract surgeries in 2010-11 acceptable compared withInternational dataPrevious annual rates
Increasing the surgical load did not adversely affect the surgical outcomes
Unplanned AV rate 2010-11 17