Appropriateness of phacoemulsification in Spain

Objective. To evaluate the appropriateness of phacoemulsification procedures performed in four Spanish regions, applying criteria developed by means of RAND/UCLA methodology. Design. Prospective observational study. Setting. Seventeen public teaching hospitals in four regions of Spain. Participants. Patients on waiting list to undergo cataract extraction by phacoemulsification. Intervention. Cataract surgery by phacoemulsification. Main Outcome Measure. Level of appropriateness of each intervention, according to criteria developed by means of the RAND/UCLA appropriateness methodology. Results. Among the 5442 analysed patients the indication of phacoemulsification was appropriate in 69.6%, inappropriate in 7.3% and uncertain in 23.0%. Presence of ocular comorbidity, lack of cataract-induced visual function limitation, anticipated postoperative visual acuity of ,0.5, preoperative visual acuity of .0.1 and high surgical complexity were associated with inappropriateness. Conclusions. Some clinical characteristics, when present, make it especially important to obtain a careful assessment of the risks and benefits of surgery. Consideration of these characteristics may improve the appropriateness of phacoemulsification.