Implementation of a Modified Risk Stratification Score in Cataract Surgery at a Swiss Public Hospital

This study evaluates the impact of a modified risk stratification system on intraoperative complication rates in cataract surgeries conducted at a Swiss Public Hospital. In this retrospective study cataract surgeries were analyzed before and after implementation of the Triemli Cataract Score (TCS) at a public referral hospital. The TCS was utilized to classify patients preoperatively based on their risk profile, categorizing cases into three levels of complexity: "routine", "complex", and "highly complex". The primary endpoint is the frequency of intraoperative complications pre-/post-TCS implementation, as well as alignment with the designated risk groups. A total of 1776 eyes were included in the study, with 704 eyes (39.6%) assessed prior to and 1072 (60.4%) post-TCS implementation. Overall, intraoperative complications were observed in 146 surgeries (8.2%), with a higher incidence observed before (9.5%) compared to post-TCS (7.4%; p=0.054). Post-TCS, 625 (63.2%) were classified as "routine", 250 eyes (25.3%) as "complex", and 113 eyes (11.4%) as "highly complex", based on their risk factors. The intraoperative complication rate varied significantly among these groups (p=0.014): the lowest rate was seen in the routine group (5.6%), followed by the highly complex group (8.8%), and the highest in the complex group (11.2%). Implementing a risk stratification system for cataract surgery enables efficient and consistent preoperative categorization of patients into defined risk groups. This approach has the potential to reduce intraoperative complications, improve the comparability of study outcomes, streamline the classification process for surgeons, and establish structured checkpoints for training ophthalmic surgeons.