Analysis of rating appropriateness and patient outcomes in cataract surgery

Using the RAND/UCLA methodology to create the appropriateness criteria, we assessed that the appropriate ratings in cataract surgery can be a better prognosis of outcomes in postoperative 12 months than uncertain or inappropriate ratings. In addition, we identified the degree of the appropriate rating surgery associated with the outcome changes in postoperative 12 months.

The patients in this study were followed up prospectively in preoperative and postoperative 12 months periods. The 20 ophthalmologists in 14 hospitals were asked to refer about 20 patients who were scheduled to undergo cataract surgery from March and June of 1997. A multiple regression analysis was used to identify the degree of the appropriate surgery associated with the changes of outcomes. The outcomes were designed as the clinical and functional outcomes (visual acuity, visual function, satisfaction with vision, and satisfaction with overall care).

The outcome changes of vision acuity (p < 0.001), vision function-14 (p < 0.001), and symptom score (p < 0.006) were significantly different between four appropriateness ratings (crucial, appropriate, uncertain, and inappropriate). There was a trend that the appropriate rating surgeries were related to the successful change of the vision function (2.29, p = 0.015) and satisfaction with vision (3.84, p = 0.014) in 12 month postoperative period.

The crucial or appropriate rating surgeries may indicate better outcomes than uncertain or inappropriate rating surgeries do. The appropriate rating surgeries were more closely related to functional outcome vision function, VF-14 and subjective outcome (satisfaction with vision) in postoperative 12 months than inappropriate rating surgeries.