International variation in anesthesia care during cataract surgery: results from the International Cataract Surgery Outcomes Study
J. C. Norregaard, O. D. Schein, L. Bellan, C. Black, J. Alonso, P. Bernth-Petersen, E. Dunn, T. F. Andersen, M. Espallargues and G. F. Anderson
Institute of Public Health, Faculty of Health Sciences, University of Copenhagen, Denmark.
OBJECTIVES: To describe international variation in anesthesia care and
monitoring during cataract surgery and to discuss its implications for cost
and safety. METHODS: A standardized questionnaire was sent to random
samples of ophthalmologists in the United States, Canada, and Barcelona,
Spain, and to all ophthalmologists in Denmark. The survey was conducted in
1993 and 1994. Certified ophthalmologists who had performed 1 or more
cataract extractions in the previous year were eligible for enrollment.
RESULTS: The response rates were 62% in the United States (n=148), 67% in
Canada (n=276), 70% in Barcelona (n=89), and 80% in Denmark (n=82). The
anesthetic technique for cataract surgery varied significantly between
sites (P<.001). Surgeons reported that retrobulbar blocks were used for
46% of the cataract extractions in the United States, 70% in Canada, 66% in
Denmark, and 31% in Barcelona. In Barcelona, general anesthesia was used
for 23% of the cataract extractions; it was used for less than 3% of the
extractions at the other 3 sites. Peribulbar blocks or topical anesthesia
was used for the remaining extractions. In the United States, Canada, and
Barcelona, surgeons reported that vital functions were monitored during
more than 97% of the extractions and anesthesia surveillance was used
during more than 78% of the extractions. In Denmark, ophthalmologists
reported that vital functions were monitored and anesthesia surveillance
was used for 1% of the cataract extractions (P<.001). CONCLUSIONS:
Substantial international variation in anesthesia care and monitoring
during cataract surgery was observed. The findings suggest a need for
further research to determine whether less intensive monitoring is
cost-effective.
