Device-Dependent Medical Intervention is Not a Panacea: Analysis of Cataract Surgery Outcomes in China from 2009 to 2018 Based on Data From the National Cataract Recovery Surgery Information Registration and Reporting System

Abstract

Background: During the last decade, support to public welfare programs, development of device-dependent techniques and increased awareness of public health have all caused rapid growth in the number of cataract surgeries performed in China. However, cataract surgery outcomes and the applicability of device-dependent interventions for cataract patients nationwide are still unknown. This study aimed to evaluate the outcomes of cataract surgeries, from a health administration perspective. The data analysed were based on the National Cataract Recovery Surgery Information Registration and Reporting System. The final objective was to provide a roadmap for future health service policies for cataract surgeries. Methods: The data source of this study is the National Cataract Recovery Surgery Information Registration and Reporting System. All cataract cases receiving any surgical treatment, both in medical services and institutes nationwide, should be registered and reported online within four days of the surgery. The variables included: medical institute settings, clinical characteristics of patients, pre-surgical examinations of the cataract-operated eyes, surgical information, and post-surgical visual status. A case-control design was adopted for this study based on the data collected from the electronic registered report system. A descriptive analysis was conducted to analyse the tendency of cataract surgery in the past decade. With LogMAR transferred, the pre-surgical best-corrected visual acuity (BCVA) level was stratified to compare the BCVA improvement level before and after the surgery. The multinomial logistic regression model was used to explore the influencing factors of 3-day post-surgical BCVA improvement, and Normogram visualisation was used to predict the prognosis of cataract surgery. Findings: A total of 1,4157,463 original records were reported from July 1st 2009 to the 31st of December 2018. The mean age of the reported data was 69.7 years, with 69% of the cases in the 61-80 years group. Female accounted for 58.0%. The median of pre-surgical LogMAR transferred BCVA was 0.2, while those of the post-surgery 3-day and 3-month were 0.5 and 0.6, respectively. Cataract surgery had a very good effect on improving post-surgical BCVA. From binary logistic regression analysis, history of hypertension (OR = 0.916) or diabetes (OR = 0.912), pre-surgical pupil abnormality (OR = 0.571), high intraocular pressure (OR = 0.578) did not affect post-surgical BCVA improvement (BCVA ≥ 6/18), while male sex (OR = 1.113), better pre-surgical BCVA level (OR = 5.996 for 0.5-0.7 and OR = 2.610 for 0.2-0.4 taken ≤ 0.1 as reference), age-related cataract (OR = 1.825), and intraocular lens implantation (OR = 1.886) were statistically beneficial for post-surgical BCVA improvement. Considering the surgery types, compared with the ECCE with large incision, the ECCE with small incision (OR value = 1.810) and the phacoemulsification (OR = 1.420) significantly improved the benefit probability. Among the hospital administration affiliation, compared with the provincial medical institutions, the benefit probability of county medical institutions was doubled, with an OR value of 2.084 (95% CI 2.029-2.140). Interpretation: ECCE with small incision has comparable effects on post-surgical BCVA improvement of phacoemulsification. Therefore, it could be an alternative cataract surgical treatment in economically underdeveloped areas in China. Funding Statement: None. Declaration of Interests: All authors claimed no conflict of interest. Ethics Approval Statement: Due to the application of the electronic data from the system, we deemed and were granted ethical approval for the study plan, data management plan and an exemption of informed consent. The approval was provided by the Ethics Committee of the National Institute of Hospital Administration in China (Ethics NO. 1015).