A cancelled cataract operation costs an NHS trust £911 per patient [1]. Non-monetary costs such as the inconvenience to the patient are also important. In the current climate of efficiency savings and increasing waiting times, it is important to minimise these disruptions. Currently in the UK, The Royal College of Ophthalmology’s Cataract Guidelines, 2017 [2] and Local Anaesthesia in Ophthalmic Surgery Guidelines in 2012 [3] state that blood pressure, blood glucose and INR measurements, are important factors to measure and control pre-operatively. The current guidance, however, does not give specific guidance of thresholds due to limited evidence. We were therefore interested to find out current practice to ascertain at which ranges for these parameters would warrant cancellation among consultants and whether local hospital guidelines are in place to standardise practices.

We carried out a 15-question survey (Fig. 1; www.surveymonkey.com) targeted at consultant Ophthalmologists across various trusts in the UK. A total of 304 consultants responded, representing 129 hospitals in the UK, and covering all Royal College of Ophthalmology specified deaneries. 35% (45) of these hospitals were reported to have a protocol for cataract cancellation in their hospital, but none of the consultants based at the same hospital gave the same parameters. Consultants from 34.9% (45) hospitals gave conflicting responses as to whether there was a protocol in place.

Fig. 1
figure 1

Questionnaire sent out to ophthalmology consultants

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Of the 304 consultants, 88% (268) would cancel patients based on blood pressure; the majority (60%, 181) gave 180/100 mmHg as their upper limit.

Eighty-seven percent (265) of consultants cancelled based on INR reading, with 40% stating they would cancel if patients were above their therapeutic range, while others gave thresholds of 3 (35%, 108) or 4 (20%, 60), or that they would undergo surgery under topical anaesthesia. Eighty one percent (246) said they do not stop other anticoagulants (including aspirin, clopidogrel, heparins and novel oral antiocoagulants) prior to surgery.

Seventy-eight percent (236) of consultants cancelled based on blood glucose, with 40% (121) stating above 25 mmol/L, and 32% (97) above 15 mmol/L.

Of all the criteria, heart rate gave the most variable response, with only 40% (123) considering it as a reason for cancellation. There was a huge variety in the upper limit, and symptomatic tachycardia understandably was the most important reason (14.8%, 45) rather than the rate.

Consultants across the UK show some consensus on when to cancel patients in relation to blood pressure, blood glucose, INR level and most do not routinely stop other forms of anticoagulation. However, there remains some variability in practice, which is understandable given the lack of specific guidance at present. Studies looking at the influence that these factors may have on cataract surgery are currently limited. A national audit looking at these parameters in relation to complications may be warranted. Our survey highlights a need for more exploration into the immediate pre-operative management of patients.