Intraoperative clinical practice and risk of early complications after cataract extraction in the United States, Canada, Denmark, and Spain

Jens Christian Norregaard, Peter Bernth-Petersen, Lorne Bellan, Jordi Alonso, Charlyn Black, Elaine Dunn, Tavs Folmer Andersen, Mireia Espallargues, Gerard F Anderson

Research output: Contribution to journalArticle

Abstract

Objective: To examine variation in intraoperative clinical practice and rates of adverse events after cataract surgery across four different healthcare systems. Design: Multicenter cohort study. Participants: Patients were recruited from ophthalmic clinics in the United States (n = 75); in the Province of Manitoba, Canada (n = 12); in Denmark (n = 17); and the City of Barcelona, Spain (n = 10). In all, 1420 patients undergoing first eye cataract surgery were enrolled, with preoperative, perioperative, and postoperative clinical data collected on 1344 patients (95%). Main Outcome Measures: Occurrence of 23 specified intraoperative and early postoperative adverse events was measured. Four-month postoperative visual acuity outcome also was measured. Results: Phacoemulsification was performed in two thirds of the extractions in the United States and Manitoba, in one third in Denmark, and in 3% in Barcelona (P <0.001). More than 96% of extractions in North America and Denmark were performed with the patient under local anesthesia, whereas general anesthesia was used for 38% of extractions in Barcelona (P <0.001). Rates of intraoperative adverse events were 11% to 12.8% in Manitoba, Denmark, and Barcelona and significantly lower in the United States (6%), mainly because of a lower rate of capsular rupture (P <0.01). Significantly higher rates of early postoperative events were seen in the United States (18.8%) and Manitoba (20.4%) compared to Denmark (7.9%) and Barcelona (5%) (P <0.001). The differences among sites in rates of events could not be explained by differences in recorded patient characteristics or surgical techniques. The occurrence of perioperative events was significantly associated with a worse 4-month visual outcome. Conclusion: The observed variation in clinical practice might represent a general trend of a slower diffusion of new medical technology in Europe compared with that of North America. Rates of intraoperative and early postoperative events varied significantly across sites.

Original languageEnglish (US)
Pages (from-to)42-48
Number of pages7
JournalOphthalmology
Volume106
Issue number1
StatePublished - Jan 1 1999

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Cataract Extraction
Manitoba
Denmark
Spain
Canada
North America
Cataract
Phacoemulsification
Local Anesthesia
General Anesthesia
Visual Acuity
Multicenter Studies
Rupture
Cohort Studies
Outcome Assessment (Health Care)
Technology
Delivery of Health Care

ASJC Scopus subject areas

  • Ophthalmology

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Intraoperative clinical practice and risk of early complications after cataract extraction in the United States, Canada, Denmark, and Spain. / Norregaard, Jens Christian; Bernth-Petersen, Peter; Bellan, Lorne; Alonso, Jordi; Black, Charlyn; Dunn, Elaine; Andersen, Tavs Folmer; Espallargues, Mireia; Anderson, Gerard F.

In: Ophthalmology, Vol. 106, No. 1, 01.01.1999, p. 42-48.

Research output: Contribution to journalArticle

Norregaard, JC, Bernth-Petersen, P, Bellan, L, Alonso, J, Black, C, Dunn, E, Andersen, TF, Espallargues, M & Anderson, GF 1999, 'Intraoperative clinical practice and risk of early complications after cataract extraction in the United States, Canada, Denmark, and Spain', Ophthalmology, vol. 106, no. 1, pp. 42-48.
Norregaard JC, Bernth-Petersen P, Bellan L, Alonso J, Black C, Dunn E et al. Intraoperative clinical practice and risk of early complications after cataract extraction in the United States, Canada, Denmark, and Spain. Ophthalmology. 1999 Jan 1;106(1):42-48.
Norregaard, Jens Christian ; Bernth-Petersen, Peter ; Bellan, Lorne ; Alonso, Jordi ; Black, Charlyn ; Dunn, Elaine ; Andersen, Tavs Folmer ; Espallargues, Mireia ; Anderson, Gerard F. / Intraoperative clinical practice and risk of early complications after cataract extraction in the United States, Canada, Denmark, and Spain. In: Ophthalmology. 1999 ; Vol. 106, No. 1. pp. 42-48.
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abstract = "Objective: To examine variation in intraoperative clinical practice and rates of adverse events after cataract surgery across four different healthcare systems. Design: Multicenter cohort study. Participants: Patients were recruited from ophthalmic clinics in the United States (n = 75); in the Province of Manitoba, Canada (n = 12); in Denmark (n = 17); and the City of Barcelona, Spain (n = 10). In all, 1420 patients undergoing first eye cataract surgery were enrolled, with preoperative, perioperative, and postoperative clinical data collected on 1344 patients (95{\%}). Main Outcome Measures: Occurrence of 23 specified intraoperative and early postoperative adverse events was measured. Four-month postoperative visual acuity outcome also was measured. Results: Phacoemulsification was performed in two thirds of the extractions in the United States and Manitoba, in one third in Denmark, and in 3{\%} in Barcelona (P <0.001). More than 96{\%} of extractions in North America and Denmark were performed with the patient under local anesthesia, whereas general anesthesia was used for 38{\%} of extractions in Barcelona (P <0.001). Rates of intraoperative adverse events were 11{\%} to 12.8{\%} in Manitoba, Denmark, and Barcelona and significantly lower in the United States (6{\%}), mainly because of a lower rate of capsular rupture (P <0.01). Significantly higher rates of early postoperative events were seen in the United States (18.8{\%}) and Manitoba (20.4{\%}) compared to Denmark (7.9{\%}) and Barcelona (5{\%}) (P <0.001). The differences among sites in rates of events could not be explained by differences in recorded patient characteristics or surgical techniques. The occurrence of perioperative events was significantly associated with a worse 4-month visual outcome. Conclusion: The observed variation in clinical practice might represent a general trend of a slower diffusion of new medical technology in Europe compared with that of North America. Rates of intraoperative and early postoperative events varied significantly across sites.",
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AU - Norregaard, Jens Christian

AU - Bernth-Petersen, Peter

AU - Bellan, Lorne

AU - Alonso, Jordi

AU - Black, Charlyn

AU - Dunn, Elaine

AU - Andersen, Tavs Folmer

AU - Espallargues, Mireia

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N2 - Objective: To examine variation in intraoperative clinical practice and rates of adverse events after cataract surgery across four different healthcare systems. Design: Multicenter cohort study. Participants: Patients were recruited from ophthalmic clinics in the United States (n = 75); in the Province of Manitoba, Canada (n = 12); in Denmark (n = 17); and the City of Barcelona, Spain (n = 10). In all, 1420 patients undergoing first eye cataract surgery were enrolled, with preoperative, perioperative, and postoperative clinical data collected on 1344 patients (95%). Main Outcome Measures: Occurrence of 23 specified intraoperative and early postoperative adverse events was measured. Four-month postoperative visual acuity outcome also was measured. Results: Phacoemulsification was performed in two thirds of the extractions in the United States and Manitoba, in one third in Denmark, and in 3% in Barcelona (P <0.001). More than 96% of extractions in North America and Denmark were performed with the patient under local anesthesia, whereas general anesthesia was used for 38% of extractions in Barcelona (P <0.001). Rates of intraoperative adverse events were 11% to 12.8% in Manitoba, Denmark, and Barcelona and significantly lower in the United States (6%), mainly because of a lower rate of capsular rupture (P <0.01). Significantly higher rates of early postoperative events were seen in the United States (18.8%) and Manitoba (20.4%) compared to Denmark (7.9%) and Barcelona (5%) (P <0.001). The differences among sites in rates of events could not be explained by differences in recorded patient characteristics or surgical techniques. The occurrence of perioperative events was significantly associated with a worse 4-month visual outcome. Conclusion: The observed variation in clinical practice might represent a general trend of a slower diffusion of new medical technology in Europe compared with that of North America. Rates of intraoperative and early postoperative events varied significantly across sites.

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