Sir,
The Cataract National Dataset audit of Narendran et al1 devised a simple method for calculating a composite bespoke risk for posterior capsule rupture (PCR) or vitreous loss (VL) or both, tailored to an individual cataract operation. The authors suggested that other surgeons could use their method for calculating the probability of this ‘index complication’.2, 3
We hypothesised that patients on our weekly cataract list for patients with co-existing retinal disorders, such as diabetic retinopathy, uveitis, retinitis pigmentosa, and high myopia at a tertiary referral centre would have a higher risk of PCR or VL or both than the average operation in the national audit.1 The national audit data represents current best practice.4 Using logistic regression analysis on over 55 000 patients, they calculated the odds ratios of PCR or VL or both for each risk factor.1 Using these odds ratios, we were able to calculate, for each of our patients, the predicted probability of a complication from the cumulative odds ratios for each patient's individual risk factors. We did this prospectively for 100 consecutive patients on our lists and also recorded whether a complication occurred or not. Thus, we were able to compare the rate of complication on our case-mix of patients against the predicted rate of complication for our patients based on national best practice.
Using the methods outlined above, we calculated the overall predicted ‘PCR or VL or both’ complication rate for our patients to be 5%, significantly higher than the overall complication rate of 1.92% in the national audit. The actual complication rate for our patients was 1% (ie, one patient in their eighties with diabetic retinopathy, primary angle closure glaucoma, brunescent cataract, a medium-sized pupil, and operated on by a Fellow).
We agree with the authors of the national audit that their data can be used to assess complication rates in cataract surgery taking into account complexity of case-mix. Overall predicted complication rate can be used to demonstrate higher-risk caseload on a particular operating list to ensure assignment of appropriately experienced surgeons. Actual vs predicted complication rate can indicate good clinical practice and appropriate experience of trainees.
References
Narendran N, Jaycock P, Johnston RL, Taylor H, Adams M, Tole DM et al. The Cataract National Dataset electronic multicentre audit of 55567 operations: risk stratification for posterior capsule rupture and vitreous loss. Eye 2009; 23: 31–37.
Desai P, Minassian DC, Reidy A . National cataract surgery survey 1997–1998: a report of the results of the clinical outcomes. Br J Ophthalmol 1999; 83: 1336–1340.
Zaidi FH, Corbett MC, Burton BJ, Bloom PA . Raising the benchmark for the 21st century – the 1000 cataract operations audit and survey: outcomes, consultant-supervised training and sourcing NHS choice. Br J Ophthalmol 2006; 91: 731–736.
Jaycock P, Johnston RL, Taylor H, Adams M, Tole DM, Galloway P et al. The Cataract National Dataset Electronic Multi-centre audit of 55567: updating benchmark standards of care in the United Kingdom and internationally. Eye 2009; 23: 38–49.
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Addison, P., Rajendram, R., Bradshaw, H. et al. Using data from the Cataract National Dataset electronic multicentre audit to calculate risk of posterior capsule rupture and vitreous loss for patients on current surgical lists. Eye 25, 396–397 (2011). https://doi.org/10.1038/eye.2011.15
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DOI: https://doi.org/10.1038/eye.2011.15
