Assessment of Appropriateness of Cataract Surgery at Ten Academic Medical Centers in 1990

Published In: Ophthalmology, v. 103, Feb. 1996, p. 207-215

Posted on RAND.org on January 01, 1996

by Joanne Tobacman, Paul Lee, Bridget Zimmerman, Hansjoerg Kolder, Lee H. Hilborne, Robert H. Brook

Develops criteria for the appropriateness of cataract surgery (extra-capsular cataract extraction or phacoemulsification with planned implantation of a posterior chamber intraocular lens) using a multidisciplinary expert panel and applied them to patients with cataract surgery from ten academic medical centers retrospectively. Approximately 2% of the procedures were classified as inappropriate, 91% as appropriate (52%) or appropriate and crucial (39%), and 7% as uncertain. Significant variation occurred in the results among the different institutions: inappropriate surgeries ranged from 0% to 4%, uncertain from 1% to 14%, appropriate from 35% to 66%, and appropriate and crucial from 21% to 62% (P = 0.02). A small percentage of cataract surgeries was performed at these ten academic medical centers for nappropriate indications according to the study criteria. Significant variation existed among the institutions in the distribution of appropriate and crucial and appropriate compared with uncertain and inappropriate surgeries.

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