A predictive scoring system for anesthesiologist intervention in cataract surgery

Purpose: To develop a preoperative risk score to predict the need for anesthesiologist intervention during cataract surgery under topical anesthesia, aiming to minimize the routine anesthesiologists’ presence in the operating room without compromising patient safety. Methods: This retrospective observational study included 817 patients who underwent phacoemulsification with intraocular lens implantation under topical anesthesia at the Eye Clinic of Trieste from April to October 2022. Preoperative ocular and systemic data were analysed. Univariate and multivariate logistic regression analyses were used to identify significant predictors of anesthesiologist intervention, forming a scoring system. The optimal cut-off value of the scoring system was determined using the receiver operating characteristic (ROC) curve analysis, with Youden's Index applied to maximize sensitivity and specificity Results: Key risk factors for anesthesiologist intervention included advanced age (>90 years), corneal opacities, retinal pathologies that required intravitreal treatment, high-grade cataract opacity (LOCS III stages 5 and 6), poor mydriasis (pupil diameter <4.0 mm), poor patient compliance, shallow anterior chamber depth (<2.5 mm), and phacodonesis. The scoring system demonstrated 73.5% sensitivity and 69.2% specificity, with a cut-off correlating with a higher likelihood of intervention. Conclusion: The proposed preoperative risk score effectively identifies patients needing anesthesiologist involvement during cataract surgery, optimizing resource allocation. Further studies should incorporate additional systemic health parameters to enhance predictive capability, promoting efficient and safe surgical practices in ophthalmology.