title: Validation of Najjar-Awwad cataract surgery risk score for resident phacoemulsification surgery.
abstract: OBJECTIVE
  To validate the Najjar-Awwad cataract surgery risk score for residents, which has been proposed to predict surgical complexity and risk.
  
  
  METHODS
  Two urban public county hospitals.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Phacoemulsification cataract surgeries performed by residents between January 2005 and April 2008 were retrospectively reviewed. The cataract risk score was calculated retrospectively. Intraoperative complications included posterior and anterior capsular tears, vitreous prolapse, dropped nucleus, and conversion to manual extracapsular cataract extraction.
  
  
  RESULTS
  Of the cases performed by 33 residents, 1833 met the inclusion criteria. There were 120 complications (6.5%); the rate of complications involving vitreous prolapse or loss (including dropped nucleus) was 3.2%. Significant risk factors in the risk score associated with intraoperative complications were dense nuclear sclerosis (odds ratio [OR], 2.08; 95% confidence interval [CI], 1.32-3.26; P = .004) and poor red reflex (OR, 2.10; 95% CI, 1.45-3.06; P = .00007). Cataract risk scores ranged from 3 to 16. The score was less than 5 in 85 cases (4.6%) and less than 7 in 885 cases (48.3%). The OR for complications increased significantly when the risk score was higher than 6 (OR, 2.11; 95% CI, 1.42-3.14; P = .0002).
  
  
  CONCLUSIONS
  Although the Najjar-Awwad cataract surgery risk score can be used to predict intraoperative complications at the time of cataract surgery, the complication rate did not significantly increase until the score reached 7. There were few cases with scores lower than 5 in these county hospital populations. Beginning surgeons should be given cases with a risk score of less than 7.
authors.affiliation: Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9057, USA. preston.blomquist@utsouthwestern.edu
authors.forename: Preston H
authors.initials: PH
authors.lastname: Blomquist
authors.forename: James W
authors.initials: JW
authors.lastname: Sargent
authors.forename: Heather H
authors.initials: HH
authors.lastname: Winslow
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004503:Education, Medical, Graduate; D005260:Female; D006766:Hospitals, County; D006786:Hospitals, Urban; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data*; D007431:Intraoperative Complications; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D009885:Ophthalmology / Q000193:education*; D018918:Phacoemulsification; D012189:Retrospective Studies; D012307:Risk Factors; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult