title: Appropriateness of phacoemulsification in Spain.
abstract: OBJECTIVE
  To evaluate the appropriateness of phacoemulsification procedures performed in four Spanish regions, applying criteria developed by means of RAND/UCLA methodology.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Seventeen public teaching hospitals in four regions of Spain.
  
  
  METHODS
  Patients on waiting list to undergo cataract extraction by phacoemulsification.
  
  
  METHODS
  Cataract surgery by phacoemulsification.
  
  
  METHODS
  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.
authors.affiliation: Unidad de Evaluación de Tecnologías Sanitarias, Agencia Laín Entralgo, C/ Gran Vía 27, 28013 Madrid, Spain. nerea.fernandez@salud.madrid.org
authors.forename: Nerea Fernández
authors.initials: NF
authors.lastname: de Larrea
authors.forename: Juan Antonio
authors.initials: JA
authors.lastname: Blasco
authors.forename: Urko
authors.initials: U
authors.lastname: Aguirre
authors.forename: Susana
authors.initials: S
authors.lastname: García
authors.forename: Belén
authors.initials: B
authors.lastname: Elizalde
authors.forename: Gemma
authors.initials: G
authors.lastname: Navarro
authors.forename: Sabina
authors.initials: S
authors.lastname: Pérez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012959:Socioeconomic Factors; D013030:Spain; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*