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Appropriateness of phacoemulsification in Spain
Nerea Fernández de Larrea1, Juan Antonio Blasco, Urko Aguirre
1Unidad de Evaluación de Tecnologías Sanitarias, Agencia Laín Entralgo, C/ Gran Vía 27, 28013 Madrid, Spain. nerea.fernandez@salud.madrid.org
Objective:
To evaluate the appropriateness of phacoemulsification procedures performed in four Spanish regions, applying criteria developed by means of RAND/UCLA methodology.
Design:
Prospective observational study.
Setting:
Seventeen public teaching hospitals in four regions of Spain.
Participants:
Patients on waiting list to undergo cataract extraction by phacoemulsification.
Intervention:
Cataract surgery by phacoemulsification.
Main Outcome Measure:
Level of appropriateness of each intervention, according to criteria developed by means of the RAND/UCLA appropriateness methodology.
Results:
Among the 5442 analysed patients the indication of phacoemulsification was appropriate in 69.6%, inappropriate in 7.3% and uncertain in 23.0%. Presence of ocular comorbidity, lack of cataract-induced visual function limitation, anticipated postoperative visual acuity of <0.5, preoperative visual acuity of >0.1 and high surgical complexity were associated with inappropriateness.
Conclusions:
Some clinical characteristics, when present, make it especially important to obtain a careful assessment of the risks and benefits of surgery. Consideration of these characteristics may improve the appropriateness of phacoemulsification.
