title: Office-Based Cataract Surgery: Population Health Outcomes Study of More than 21 000 Cases in the United States.
abstract: OBJECTIVE
  To identify safety and effectiveness outcomes of office-based cataract surgery. Each year, approximately 3.7 million cataract surgeries in the United States are performed in Ambulatory Surgery Center (ASC) and Hospital Outpatient Department (HOPD) locations. Medicare in July 2015 published a solicitation for expert opinion on reimbursing office-based cataract surgery.
  
  
  METHODS
  Large-scale, retrospective, consecutive case series of cataract surgeries performed in Minor Procedure Rooms (MPRs) of a large US integrated healthcare center.
  
  
  METHODS
  More than 13 500 patients undergoing elective office-based cataract surgery.
  
  
  METHODS
  Phacoemulsification cataract surgery performed in MPRs of Kaiser Permanente Colorado from 2011 to 2014.
  
  
  METHODS
  Postoperative visual acuity and intraoperative and postoperative adverse events (AEs).
  
  
  RESULTS
  Office-based cataract surgery was completed in 21 501 eyes (13 507 patients, age 72.6±9.6 years). Phacoemulsification was performed in 99.9% of cases, and manual extracapsular extraction was performed in 0.1% of cases. Systemic comorbidities included hypertension (53.5%), diabetes (22.3%), and chronic obstructive pulmonary disease (9.4%). Postoperative mean best-corrected visual acuity measured 0.14±0.26 logarithm of the minimum angle of resolution units. Intraoperative ocular AEs included 119 (0.55%) cases of capsular tear and 73 (0.34%) cases of vitreous loss. Postoperative AEs included iritis (n = 330, 1.53%), corneal edema (n = 110, 0.53%), and retinal tear or detachment (n = 30, 0.14%). No endophthalmitis was reported. Second surgeries were performed in 0.70% of treated eyes within 6 months. There were no life- or vision-threatening intraoperative or perioperative AEs.
  
  
  CONCLUSIONS
  This is the largest US study to investigate the safety and effectiveness of office-based cataract surgery performed in MPRs. Office-based efficacy outcomes were consistently excellent, with a safety profile expected of minimally invasive cataract procedures performed in ASCs and HOPDs.
authors.affiliation: University of California, San Francisco, San Francisco, California. Electronic address: sean@ianchulev.com.
authors.forename: Tsontcho
authors.initials: T
authors.lastname: Ianchulev
authors.affiliation: Colorado Permanente Medical Group, Lafayette, Colorado.
authors.forename: David
authors.initials: D
authors.lastname: Litoff
authors.affiliation: Colorado Kaiser Permanente Health Plan, Wheat Ridge, Colorado.
authors.forename: Donna
authors.initials: D
authors.lastname: Ellinger
authors.affiliation: Colorado Permanente Medical Group, Lone Tree, Colorado.
authors.forename: Kent
authors.initials: K
authors.lastname: Stiverson
authors.affiliation: Oregon Health & Science University, Portland, Oregon.
authors.forename: Mark
authors.initials: M
authors.lastname: Packer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities / Q000592:standards; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects / Q000592:standards*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D018918:Phacoemulsification / Q000009:adverse effects / Q000592:standards*; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States; D014792:Visual Acuity / Q000502:physiology*