Cataract risk stratification and prioritisation protocol in the COVID-19 era
Abstract Background The COVID-19 pandemic halted non-emergency surgery across Scotland. Measures to mitigate the risks of transmitting COVID-19 are creating significant challenges to restarting all surgical services safely. We describe the development of a risk stratification tool to prioritise pati...
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doaj-8122823401d64f6696083eddd4eb07342021-02-21T12:08:45ZengBMCBMC Health Services Research1472-69632021-02-012111910.1186/s12913-021-06165-1Cataract risk stratification and prioritisation protocol in the COVID-19 eraKelvin KW Cheng0Martin J Anderson1Stavros Velissaris2Robert Moreton3Ahmed Al-Mansour4Roshini Sanders5Shona Sutherland6Peter Wilson7Andrew Blaikie8Ophthalmology Department, NHS Fife, Queen Margaret HospitalOphthalmology Department, NHS Fife, Queen Margaret HospitalOphthalmology Department, NHS Fife, Queen Margaret HospitalOphthalmology Department, NHS Fife, Queen Margaret HospitalOphthalmology Department, NHS Fife, Queen Margaret HospitalOphthalmology Department, NHS Fife, Queen Margaret HospitalOphthalmology Department, NHS Fife, Queen Margaret HospitalOphthalmology Department, NHS Fife, Queen Margaret HospitalOphthalmology Department, NHS Fife, Queen Margaret HospitalAbstract Background The COVID-19 pandemic halted non-emergency surgery across Scotland. Measures to mitigate the risks of transmitting COVID-19 are creating significant challenges to restarting all surgical services safely. We describe the development of a risk stratification tool to prioritise patients for cataract surgery taking account both specific risk factors for poor outcome from COVID-19 infection as well as surgical ‘need’. In addition we report the demographics and comorbidities of patients on our waiting list. Methods A prospective case review of electronic records was performed. A risk stratification tool was developed based on review of available literature on systemic risk factors for poor outcome from COVID-19 infection as well as a surgical ‘need’ score. Scores derived from the tool were used to generate 6 risk profile groups to allow prioritised allocation of surgery. Results There were 744 patients awaiting cataract surgery of which 66 (8.9 %) patients were ‘shielding’. One hundred and thirty-two (19.5 %) patients had no systemic comorbidities, 218 (32.1 %) patients had 1 relevant systemic comorbidity and 316 (46.5 %) patients had 2 or more comorbidities. Five hundred and ninety patients (88.7 %) did not have significant ocular comorbidities. Using the risk stratification tool, 171 (23 %) patients were allocated in the highest 3 priority stages. Given an aging cohort with associated increase in number of systemic comorbidities, the majority of patients were in the lower priority stages 4 to 6. Conclusions COVID-19 has created an urgent challenge to deal safely with cataract surgery waiting lists. This has driven the need for a prompt and pragmatic change to the way we assess risks and benefits of a previously regarded as low-risk intervention. This is further complicated by the majority of patients awaiting cataract surgery being elderly with comorbidities and at higher risk of mortality related to COVID-19. We present a pragmatic method of risk stratifying patients on waiting lists, blending an evidence-based objective assessment of risk and patient need combined with an element of shared decision-making. This has facilitated safe and successful restarting of our cataract service.https://doi.org/10.1186/s12913-021-06165-1 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Kelvin KW Cheng Martin J Anderson Stavros Velissaris Robert Moreton Ahmed Al-Mansour Roshini Sanders Shona Sutherland Peter Wilson Andrew Blaikie |
spellingShingle |
Kelvin KW Cheng Martin J Anderson Stavros Velissaris Robert Moreton Ahmed Al-Mansour Roshini Sanders Shona Sutherland Peter Wilson Andrew Blaikie Cataract risk stratification and prioritisation protocol in the COVID-19 era BMC Health Services Research |
author_facet |
Kelvin KW Cheng Martin J Anderson Stavros Velissaris Robert Moreton Ahmed Al-Mansour Roshini Sanders Shona Sutherland Peter Wilson Andrew Blaikie |
author_sort |
Kelvin KW Cheng |
title |
Cataract risk stratification and prioritisation protocol in the COVID-19 era |
title_short |
Cataract risk stratification and prioritisation protocol in the COVID-19 era |
title_full |
Cataract risk stratification and prioritisation protocol in the COVID-19 era |
title_fullStr |
Cataract risk stratification and prioritisation protocol in the COVID-19 era |
title_full_unstemmed |
Cataract risk stratification and prioritisation protocol in the COVID-19 era |
title_sort |
cataract risk stratification and prioritisation protocol in the covid-19 era |
publisher |
BMC |
series |
BMC Health Services Research |
issn |
1472-6963 |
publishDate |
2021-02-01 |
description |
Abstract Background The COVID-19 pandemic halted non-emergency surgery across Scotland. Measures to mitigate the risks of transmitting COVID-19 are creating significant challenges to restarting all surgical services safely. We describe the development of a risk stratification tool to prioritise patients for cataract surgery taking account both specific risk factors for poor outcome from COVID-19 infection as well as surgical ‘need’. In addition we report the demographics and comorbidities of patients on our waiting list. Methods A prospective case review of electronic records was performed. A risk stratification tool was developed based on review of available literature on systemic risk factors for poor outcome from COVID-19 infection as well as a surgical ‘need’ score. Scores derived from the tool were used to generate 6 risk profile groups to allow prioritised allocation of surgery. Results There were 744 patients awaiting cataract surgery of which 66 (8.9 %) patients were ‘shielding’. One hundred and thirty-two (19.5 %) patients had no systemic comorbidities, 218 (32.1 %) patients had 1 relevant systemic comorbidity and 316 (46.5 %) patients had 2 or more comorbidities. Five hundred and ninety patients (88.7 %) did not have significant ocular comorbidities. Using the risk stratification tool, 171 (23 %) patients were allocated in the highest 3 priority stages. Given an aging cohort with associated increase in number of systemic comorbidities, the majority of patients were in the lower priority stages 4 to 6. Conclusions COVID-19 has created an urgent challenge to deal safely with cataract surgery waiting lists. This has driven the need for a prompt and pragmatic change to the way we assess risks and benefits of a previously regarded as low-risk intervention. This is further complicated by the majority of patients awaiting cataract surgery being elderly with comorbidities and at higher risk of mortality related to COVID-19. We present a pragmatic method of risk stratifying patients on waiting lists, blending an evidence-based objective assessment of risk and patient need combined with an element of shared decision-making. This has facilitated safe and successful restarting of our cataract service. |
url |
https://doi.org/10.1186/s12913-021-06165-1 |
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