NEWS & OPINION EWAP DECEMBER 2022 35 by Aakriti G. Shukla, MD, and David F. Chang, MD Contact information Chang: dceye@earthlink.net Shukla: ag2965@cumc.columbia.edu Sustaining safe, quality, cost -effective care: A clinical registry study at the Aravind Eye Care System assessing traditional and Western operating room practices T he healthcare sector is responsible for 10% of greenhouse gas emissions produced in the U.S.1 ORs and labor and delivery services produce 70% of medical waste. With 29 million cataract surgeries performed globally in 2019, procedural volumes in ophthalmology are the highest of any specialty.2 As ophthalmologists, we have the potential to make impactful change by informing policy and modifying wasteful practices. Most ophthalmologists are in agreement with this; a recent survey-based study with more than 1,000 respondents found that 93% of cataract surgeons think that approaches to reduce OR waste should be developed.3 The Aravind Eye Care System (AECS) is globally recognized for its forward-thinking eyecare models. This group of 14 regional eye hospitals in south India has consistently demonstrated delivery of safe, cost-effective, high-volume ophthalmic surgery with excellent outcomes.4,5 These accomplishments are accompanied by AECS’s focus on environmental and economic sustainability. Twenty cataract surgeries at AECS create the same level of carbon emissions as one cataract surgery in the U.K.6 More than 50% of surgeries performed at AECS are offered for free or at a steeply discounted price; despite this, the organization is consistently profitable. The British Journal of Ophthalmology recently published a study from our group, titled “Changing Operating Room Practices: The Effect on Postoperative Endophthalmitis Rates Following Cataract Surgery.”7 When AECS resumed surgery following the April 2020 pandemic lockdown, they adopted four new OR protocols designed to reduce the risk of COVID-19 transmission. This retrospective, sequential, clinical registry study analyzed whether these more stringent protocols, which are mandatory in the U.S., reduced Aravind’s rate of postoperative endophthalmitis following cataract surgery. The study included consecutive patients who underwent cataract surgery at the Madurai regional AECS hospital during 2020. Two groups were compared; Group 1 underwent surgery prior to the institution of COVID-19 protocols (between January 1, 2020, and March 30, 2020) and Group 2 underwent surgery following the new protocol adoption (between May 1, 2020, and August 1, 2020). April 2020 was not included in the analysis because surgery was limited to emergency or non-elective procedures. Group 2’s time period was longer because of reduced surgical volume due to the pandemic. Outcome measures were the rate of postoperative endophthalmitis and complications such as posterior capsular rupture and zonular dialysis. The four changes are described in Table 1. Aside from these modifications, the surgical and perioperative protocols were identical for the two groups. Postoperative outcomes are described in Table 2. A total of 85,562 cataract surgeries were included in the study, of This article originally appeared in the September 2022 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. Table 1. Surgical protocol at baseline and during COVID-19.
RkJQdWJsaXNoZXIy Njk2NTg0