France Catches Up With 250,000-Case Backlog

Safe short circuit for cataract surgery reduces need for anaesthesiologist. Dermot McGrath reports

Cataract surgery can be performed safely with a high degree of patient satisfaction without perioperative anaesthetic care, according to a study presented at the online annual meeting of the French Society of Ophthalmology (SFO). Successful, safe surgery can occur in an outpatient or hospital setting under topical anaesthesia.

“Our experience has shown that a secure short circuit (SSC) for surgeries of the anterior segment of the eye under topical anaesthesia can be safely and effectively implemented. This corresponds with the increased need for cataract surgery in the wake of the COVID-19 crisis and the ongoing shortage of anaesthesiologists in certain regions,” said Bahram Bodaghi MD, PhD, FEBO.

Dr Bodaghi, Professor of Ophthalmology and Visual Sciences at the University of Pierre and Marie Curie in Paris, France, said creative solutions are absolutely necessary to respond to the growing demand for healthcare in a context of demographic and post-COVID-19 pressure.

“More than 900,000 phacoemulsification surgeries were carried out in France in 2019, which was reduced by 250,000 in 2020 in connection to COVID-19. The situation is still under stress in 2021, with a net reduction in resources in terms of available anaesthesiologists in both private and public healthcare. The problem has also been exacerbated due to the uneven distribution of ophthalmologists in certain regions in France, particularly rural areas and medical deserts where healthcare providers are severely lacking,” he said.

The French National Authority for Health (HAS) has loosened the regulations regarding the use of anaesthesia for cataract surgery within the last few years, Dr Bodaghi explained.

In a recent update, HAS emphasised the choice of technique should be made in consultation between the patient, the surgeon, and the anaesthesiologist. Whatever the choice, HAS recommended a course of care providing for a preoperative anaesthesia consultation as well as intraoperative medical monitoring for all patients to secure care.

For the secure short circuit proposed in Dr Bodaghi’s retrospective study, patients were first selected by surgeons before answering a medical questionnaire. They did not have any preoperative evaluation by an anaesthesiologist, received monitoring during surgery by the surgical team, and, in case of a problem, had an intraoperative medical action (IMA) performed.

The primary outcome was identifying IMA risk factors among the patients’ medical history, followed by a case-control study. Out of 2,744 screened patients, 1,592 were included. The team found a 5% IMA rate among patients, 81% of which were for intraoperative high blood pressure. In the case-control study, regression analysis revealed a correlation between a history of high blood pressure and insulin-dependent diabetes and IMA.

When summing up the findings, Dr Bodaghi said the low incidence of IMA showed the secure short circuit as a safe strategy thanks to rigorous patient selection and an optimised and secure pathway.

Bahram Bodaghi: bahram.bodaghi@aphp.fr

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