Ambulatory cataract surgery centre without perioperative anaesthesia care: a prospective cohort study

Abstract

This study aims to evaluate the safety and patient satisfaction of a fast-track procedure for cataract surgery under topical anaesthesia without perioperative anaesthesia care. This is a prospective single-centre study including all cataract procedures in the Centre Ambulatoire de la Chirurgie de la Cataracte at the Hospital of Bourges between May and August 2018. Procedures were performed under topical anaesthesia without the presence of a nurse anaesthesiologist or anaesthesiologist, the patient had not fasted, and no peripheral venous line was placed. Only heart rate and oxygen saturation were monitored intraoperatively with pulse oximetry. Incidence and nature of intraoperative adverse events and surgical complications were recorded. Patient satisfaction was assessed using the Iowa Satisfaction with Anaesthesia Scale (ISAS). In total, 651 cataract surgeries were performed among which 614 (94.3%) were uneventful. Thirty (4.6%) intraoperative adverse events and 8 (1.2%) surgical complications were recorded. All surgeries were successfully completed. No medical emergency team intervention or hospital admittance was encountered. The mean ISAS score was 5.7/6, indicating high patient satisfaction. Cataract surgery in an ambulatory cataract surgery centre without perioperative anaesthesia care is a safe procedure with high patient satisfaction for screened patients. Anaesthesia ressources are scarce and may be more beneficial to more complex ophthalmic or non-ophthalmic surgeries.

Figure 1

Cartography of ophthalmologist density (according to area) expressed per 100,000 inhabitants (extracted from https://demographie.medecin.fr/mobile.php by MB).

Figure 2

ISAS, Iowa Satisfaction with Anaesthesia Scale (copyrighted by Franklin Dexter and the University of Iowa Research Foundation). For items 1, 3, 5, 7, 9, and 11, the scores are calculated as follows: + 6, agree very much; + 5, agree moderately; + 4, agree slightly; + 3, disagree slightly; + 2, disagree moderately; + 1, disagree very much. For items 2, 4, 6, 8, and 10, the scores are calculated in the reverse order from the aforementioned items.