| | Eye Infections (Endophthalmitis) after Cataract Surgery
Impact
Postoperative endophthalmitis is a rare occurrence, but requires prompt intervention with antibiotics because of its potential to cause loss of vision. Gundersen Lutheran monitors the incidence of infection as a complication after cataract surgery in order to demonstrate adherence to pre and postoperative techniques.
Aim
To achieve a rate lower than the benchmark for postoperative endophthalmitis following cataract surgery.
Results
Conclusions
Gundersen Lutheran achieved their aim to have an infection rate lower than the benchmark and further decreased their rate in the last 3-year study period. While there is no difference between the two Gundersen Lutheran rates (p = 0.296), there is a significant difference between the 2004-2006 Gundersen Lutheran rate and also the combined Gundersen Lutheran rate compared with the benchmark (p = 0.0145 ) and (p = <0.001) respectively. Our current protocol is effective in lowering the incidence of this complication.
Next Steps
Continue current methods in preventing endophthalmitis and re-evaluate the rate of endophthalmitis in 3 to 5 years to assure continued success in preventing this complication.
Activity Leader
Gary Lenth, MD - gjlenth@gundluth.org
Background
Cataract surgery is the most commonly performed surgical procedure in the United States with approximately 1.7 million performed annually in the Medicare population. (1) The procedure has a very high rate of success and patient satisfaction. Endophthalmitis is an uncommon, but potentially devastating, postoperative complication of eye surgery which typically occurs 1 to 2 weeks following cataract surgery. Methods utilized at Gundersen Lutheran to prevent endophthalmitis are similar to those used widely in ophthalmology and considered to be the current standard of care. (1) These methods include preoperative and postoperative topical antibiotics, preoperative application of povidine-iodine solution, and careful intraoperative aseptic technique.
Methods/Measures
All cataract procedures performed at Gundersen Lutheran over an eight-year period from January 1, 1996 through December 31, 2003 were identified by review of coding and billing data (n=10,722). A similar list was also generated from cataract procedures performed from January 1, 2004 through December 31, 2006 (n=5390). Infection could have occurred at any time following cataract surgery, but typically occurs 1 to 2 weeks following surgery. The query searched for treatment for eye infection within 30 days after surgery. Statistical testing was done using Chi Square and Fisher Exact analysis.
Benchmark
Post cataract endophthalmitis rates have been increasing since 1992, and in an eight-year study yielded an incidence rate of 2.15 per thousand eyes. (1)
References
1. West, ES, et al. The Incidence of Endophthalmitis after Cataract Surgery among the U.S. Medicare Population Increased between 1994 and 2001. Ophthalmology 2005: 112:1388 – 1394.
Acknowledgement
Jane Robinson, RHIA, Quality Improvement |