Cataract risk stratification and prioritisation protocol in the COVID-19 era
| Autor: | Roshini Sanders, Robert Berkeley Reynolds Moreton, Martin Anderson, Kelvin Cheng, Shona Sutherland, Peter Wilson, Ahmed Al-Mansour, Andrew Blaikie, S. Velissaris |
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| Přispěvatelé: | University of St Andrews. Infection and Global Health Division, University of St Andrews. School of Medicine |
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Waiting Lists medicine.medical_treatment Specific risk Cataract Extraction Comorbidity RE Ophthalmology Risk Assessment Cataract 03 medical and health sciences 0302 clinical medicine SDG 3 - Good Health and Well-being RA0421 Risk Factors RA0421 Public health. Hygiene. Preventive Medicine Epidemiology Risk of mortality Humans Medicine Prospective Studies 030212 general & internal medicine Intensive care medicine Prospective cohort study Pandemics Aged Aged 80 and over business.industry Health Policy lcsh:Public aspects of medicine RD Surgery COVID-19 lcsh:RA1-1270 3rd-DAS Cataract surgery medicine.disease Scotland Cohort 030221 ophthalmology & optometry RE Female business Risk assessment RD Research Article |
| Zdroj: | BMC Health Services Research, Vol 21, Iss 1, Pp 1-9 (2021) BMC Health Services Research |
| ISSN: | 1472-6963 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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