Validation of Najjar-Awwad cataract surgery risk score for resident phacoemulsification surgery

Purpose: To validate the Najjar-Awwad cataract surgery risk score for residents, which has been proposed to predict surgical complexity and risk. Setting: Two urban public county hospitals. Design: Case series. Methods: Phacoemulsification cataract surgeries performed by residents between January 2005 and April 2008 were retrospectively reviewed. The cataract risk score was calculated retrospectively. Intraoperative complications included posterior and anterior capsular tears, vitreous prolapse, dropped nucleus, and conversion to manual extracapsular cataract extraction. Results: Of the cases performed by 33 residents, 1833 met the inclusion criteria. There were 120 complications (6.5%); the rate of complications involving vitreous prolapse or loss (including dropped nucleus) was 3.2%. Significant risk factors in the risk score associated with intraoperative complications were dense nuclear sclerosis (odds ratio [OR], 2.08; 95% confidence interval [CI], 1.32-3.26; P = .004) and poor red reflex (OR, 2.10; 95% CI, 1.45-3.06; P = .00007). Cataract risk scores ranged from 3 to 16. The score was less than 5 in 85 cases (4.6%) and less than 7 in 885 cases (48.3%). The OR for complications increased significantly when the risk score was higher than 6 (OR, 2.11; 95% CI, 1.42-3.14; P = .0002). Conclusions: Although the Najjar-Awwad cataract surgery risk score can be used to predict intraoperative complications at the time of cataract surgery, the complication rate did not significantly increase until the score reached 7. There were few cases with scores lower than 5 in these county hospital populations. Beginning surgeons should be given cases with a risk score of less than 7.