Clinical Study
Eye (2009) 23, 38–49; doi:10.1038/sj.eye.6703015; published online 23 November 2007
The Cataract National Dataset electronic multi-centre audit of 55 567 operations: updating benchmark standards of care in the United Kingdom and internationally
P Jaycock1, R L Johnston2, H Taylor3, M Adams1, D M Tole1, P Galloway4, C Canning5, J M Sparrow1,6 and the UK EPR user group
- 1Bristol Eye Hospital, Bristol, UK
- 2Gloucestershire Eye Department, Cheltenham General Hospital, Cheltenham, UK
- 3Research and Development Support Unit, R&E Office, Bristol Royal Infirmary, Bristol, UK
- 4Eye Department, St James' University Hospital, Leeds, UK
- 5Moorfields Eye Hospital NHS Foundation Trust, London, UK
- 6International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
Correspondence: RL Johnston, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham General Hospital, Sandford Road, Cheltenham GL53 7AN, UK. Tel: +44 1242 272529; Fax: +44 1242 272585. E-mail: rob.johnston@glos.nhs.uk
Received 31 May 2007; Revised 19 September 2007; Accepted 28 September 2007; Published online 23 November 2007.
Abstract
Aims
To pilot the use of the Cataract National Dataset (CND) using multi-centre data from Electronic Patient Record (EPR) systems and to demonstrate the ability of the CND to deliver certain of its intended benefits, including detailed preoperative profiling of cataract surgery patients and updating of benchmark standards of care in the NHS and beyond.
Methods
NHS departments using EPR systems to collect a minimum preoperative, anaesthetic, operative and postoperative data set, the CND, were invited to submit data, which were remotely extracted, anonymised, assessed for conformity and completeness, and analysed.
Results
Four-hundred and six surgeons from 12 NHS Trusts submitted data on 55 567 cataract operations between November 2001 and July 2006 (86% from January 2004). Mean age (SD) was 75.4 (10.4) years, 62.0% female. Surgery was for first eyes in 58.5%, under local anaesthesia in 95.5% and by phacoemulsification in 99.7%. Trainees performed 33.9% of operations. Preoperative visual acuity (VA) was 6/12 or better in 42.9% eyes overall, in 35.3% first eyes and in 55.3% second eyes. Complication rates included the following: posterior capsule rupture and/or vitreous loss of 1.92%, simple zonule dialysis of 0.46% and retained lens fragments of 0.18%. Postoperative VA of 6/12 or better (and 6/6 or better) was achieved for 91.0% (45.9%) of all eyes, 94.7% (51.0%) of eyes with no co-pathologies and 79.9% (30.2%) of eyes with one or more co-pathologies respectively.
Conclusions
The CND is fit for purpose, is able to deliver useful benefits and can be collected as part of routine clinical care via EPR systems. This survey confirms shifts in practice since the 1997–1998 UK National Survey with full conversion to phacoemulsification, better preoperative acuity, a halving of the surgical 'index' benchmark complication of posterior capsule rupture and/or vitreous loss, and improved VA outcomes.
Keywords:
cataract surgery, Cataract National Dataset, outcome, audit, benchmark standard, Electronic Patient Record
