Cataract surgery without preanesthetic consultation: A 2-year retrospective study

Cataract surgery is the most commonly performed procedure in the world. However, certain perioperative modalities remain controversial, and the necessity of systematic performance of a preanesthetic consultation is gradually being questioned. The goal of this study was to investigate the anesthetic and surgical safety of performing cataract surgeries under topical or sub-Tenon's anesthesia without prior preanesthetic consultation.

Thus, we conducted a retrospective study at Sainte-Anne Military Teaching Hospital (Toulon, France) over the period from January 1, 2021, to December 31, 2022, including all patients admitted to the operating room for a phacoemulsification procedure performed under topical or sub-Tenon's anesthesia without prior preanesthetic consultation. Patients were referred to this simplified care pathway in the absence of: predictable surgical difficulties, significant anxiety, risk of agitation or claustrophobia, communication difficulties, lack of cooperation, difficulties in maintaining a motionless supine position, coughing or severe dyspnea or severe allergic history. The eligible patients for this care pathway were selected by the surgeon based on a list of indications. The occurrence of systemic or surgical complications, drug interventions, calls to the anesthesiologist, or unplanned hospitalization in the immediate postoperative period was recorded.

One thousand procedures were performed on 654 patients. No major systemic complications were recorded. Surgical complications occurred in 27 procedures (2.7%). Medication was administered to the patient intraoperatively during 413 (41.3%) procedures, mostly antihypertensive drugs (33.1%) and sedatives (11.5%). Aside from drug prescription, 9 calls (0.9%) were made to the anesthesiologist. There were no unplanned hospitalizations in the immediate postoperative period.

In our series, performing phacoemulsification procedures under topical or sub-Tenon's anesthesia without prior preanesthetic consultation has shown anesthetic and surgical complication rates comparable to those reported in the literature. Prospective comparative studies are needed to confirm the non-inferiority of this care pathway and to generalize its practice.