Abstract

Cataract surgery is a low-risk operation and is one of the most common procedures performed worldwide. The incidence increases with age, and many patients needing cataract surgery are elderly and often present with comorbidities. Despite the safety and brevity of lens replacement surgery, many practitioners are hesitant to subject those with comorbidities to cataract surgery and improve vision without an extensive and expensive preprocedural evaluation.

After a review of the literature, the Society for Ambulatory Anesthesia (SAMBA) published a position statement to assist anesthesiologists caring for those needing cataract surgery (Anesth Analg 2021;133:1431-36). The statement emphasizes that most patients needing cataract surgery may undergo this operation without a preoperative assessment, as this is no longer required. Pre-existing comorbidities do not need to be assessed just for the procedure. The statement reviews critical conditions that warrant postponing cataract surgery, including acute lung, cardiac, and neurological conditions, malignant hypertension, and diabetic ketoacidosis. Even obese patients may undergo this operation as long as the facility is equipped to provide for their care. Patients should continue their routine prescribed preoperative medications, including anticoagulants. The surgery itself is usually conducted using either topical or sub-Tenon analgesia. The statement does not contradict the use of general anesthesia when indicated.

Why it matters

The position statement issued by SAMBA (Anesth Analg 2021;133:1431-36) emphasizes the need to proceed with cataract surgery and restore vision in thousands of patients without and with stable, existing comorbidities. Unlike the past, current data suggests that the outcomes after cataract surgery are the same without a thorough preoperative medical assessment (Eye (Lond) 2016;30:1614-22). The statement confirms that if the patients needing cataract surgery are stable and not needing any acute intervention for a medical issue, they can undergo the operation. The benefits of restoring vision outweigh the risk of the procedure. The statement is timely because it provides confidence to anesthesiologists working in freestanding and attached ambulatory surgery centers and caring for elderly patients who typically have comorbidities. The statement is worth reading to review the acute illnesses that may dictate postponing this low-risk operation.

Kumar G. Belani, MBBS, MS, FACA, FAAP, SAMBA-F, ASA Committee on Ambulatory Surgical Care, Professor of Anesthesiology, Medicine and Pediatrics, M Health Fairview, University of Minnesota, Minneapolis, Minnesota, and Honorary International Dean, Indian College of Anesthesiologists.

Kumar G. Belani, MBBS, MS, FACA, FAAP, SAMBA-F, ASA Committee on Ambulatory Surgical Care, Professor of Anesthesiology, Medicine and Pediatrics, M Health Fairview, University of Minnesota, Minneapolis, Minnesota, and Honorary International Dean, Indian College of Anesthesiologists.

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