Risks factors and regression model for risk calculation of anesthesiologic intervention in topical and intracameral cataract surgery.
OBJECTIVE
To determine risk factors for anesthesiologist intervention during routine cataract surgery performed with topical and intracameral anesthesia and establish a regression model to identify high-risk patients.


METHODS
Department of Ophthalmology, Clínica Universidad de Navarra, Pamplona, Spain.


METHODS
Prospective case series.


METHODS
After cataract surgery at an ambulatory surgical center, anesthesia personnel completed a questionnaire to determine adverse medical events and risk factors related to anesthesiologist intervention. A Poisson regression model was used to calculate the interventional risks. Bootstrapping was performed for internal model validation.


RESULTS
Of the 1010 cases, 50 (4.95%) required anesthesiologist intervention. Univariate analysis identified an association between anesthesiologist intervention and hypertension (P<.001), psychiatric history (P=.002), initial systolic blood pressure (P<.001), surgical duration (P=.001), and diabetes (P=.018). Scores were obtained using the following proposed regression model equation: (-8.68 + 0.33 × sex [men, 0; women, 1] + -0.02 × age [years] + 0.68 × hypertensive history [no, 0; yes, 1] + 1.18 × psychiatric background [no, 0; yes, 1] + 0.04 × initial systolic blood pressure [mm Hg]). The area under the receiver-operating curve was 0.803 (95% confidence interval [CI], 0.721-0.886). The area under the curve found in the validation method was 0.813 (95% CI, 0.727-0.887).


CONCLUSIONS
Hypertension was the main risk factor for anesthesiologist intervention. The regression model discriminated between patients at lower and higher risk for intraoperative intervention for monitored anesthesia care. The probability of anesthesiologist intervention was 11.7 times higher when the model obtained a high score.


BACKGROUND
No author has a financial or proprietary interest in any material or method mentioned.
Department of Ophthalmology, Clínica Universidad de Navarra, Pamplona, Spain. jmoreno@unav.es
Javier
J
Moreno-Montañés
Alfonso L
AL
Sabater
Jesús
J
Barrio-Barrio
José Ramón
JR
Pérez-Valdivieso
Elena
E
Cacho-Asenjo
Marta
M
García-Granero
D000368:Aged; D000772:Anesthesia, Local / Q000706:statistics & numerical data; D000776:Anesthesiology / Q000706:statistics & numerical data*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001794:Blood Pressure / Q000502:physiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology; D019654:Lens Implantation, Intraocular; D016015:Logistic Models; D008297:Male; D016343:Monitoring, Intraoperative / Q000706:statistics & numerical data*; D018918:Phacoemulsification; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors
D000779:Anesthetics, Local