title: Surgical outcomes in phacoemulsification after application of a risk stratification system.
abstract: BACKGROUND
  The purpose of this study was to determine whether application of a risk stratification system during preoperative assessment of cataract patients and subsequent allocation of patients to surgeons with matching experience may reduce intraoperative complications.
  
  
  METHODS
  Nine hundred and fifty-three consecutive patients (1109 eyes) undergoing phacoemulsification cataract surgery were assigned to two groups, ie, group A (n = 498 patients, 578 eyes) and group B (n = 455 patients, 531 eyes). Patients from group A were allocated to surgeons with varying experience with only a rough estimate of the complexity of their surgery. Patients from group B were assigned to three risk groups (no added risk, low risk, and moderate-high risk) according to risk factors established during their preoperative assessment and were respectively allocated to resident surgeons, low-volume surgeons, or high-volume surgeons. Data were collected and entered into a computerized database. The intraoperative complication rate was calculated for each group.
  
  
  RESULTS
  The intraoperative complication rate was significantly lower in group B than in group A (group A, 5.88%; group B, 3.2%; P < 0.05). Patients from group B with no added risk and allocated to resident surgeons had a significantly lower rate of intraoperative complications than those from group A allocated to resident surgeons (group A, 7.2%; group B, 3.08%; P < 0.05).
  
  
  CONCLUSIONS
  Our study demonstrates that allocation of cataract patients to surgeons matched for experience according to a uniform and reliable preoperative assessment of their risk of complications allows for better surgical outcomes, especially for resident surgeons.
authors.affiliation: Second Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece.
authors.forename: Ioannis T
authors.initials: IT
authors.lastname: Tsinopoulos
authors.forename: Lampros P
authors.initials: LP
authors.lastname: Lamprogiannis
authors.forename: Konstantinos T
authors.initials: KT
authors.lastname: Tsaousis
authors.forename: Asimina
authors.initials: A
authors.lastname: Mataftsi
authors.forename: Chrysanthos
authors.initials: C
authors.lastname: Symeonidis
authors.forename: Nikolaos T
authors.initials: NT
authors.lastname: Chalvatzis
authors.forename: Stavros A
authors.initials: SA
authors.lastname: Dimitrakos
keywords: cataract; complications; resident; risk stratification