A Department-of-Anesthesiology-based management protocol for perioperative corneal abrasions

Abstract

Jessica R Lichter,1 Lawrence B Marr,2 Dennis E Schilling,3 Mark E Hudson,4 Robert H Boretsky,5 Roxana F Barad,6 Jacques E Chelly1–3 1Division of Clinical Research, Department of Anesthesiology, University of Pittsburgh, 2University of Pittsburgh Physicians, Department of Anesthesiology, UPMC Shadyside Hospital, 3UPMC Shadyside Hospital, 4University of Pittsburgh Physicians, Department of Anesthesiolgy, University of Pittsburgh Medical Center, 5Department of Anesthesiology, UPMC Shadyside, 6Department of Ophthalmology, UPMC Shadyside, University of Pittsburgh Medical Center, Pittsburgh, PA, USA Introduction: Corneal abrasions (CAs) are the most prevalent ocular injuries in the perioperative period. Previously, patients at our community hospital would wait for an ophthalmologist to be available to manage these minor injuries. To decrease this waiting period – and thereby increase patient satisfaction – we developed an anesthesiology-based protocol to manage minor CAs arising in the recovery room. The current study sought to assess this protocol’s efficacy as well as further establish the incidence and some risk factors of CA. Methods: This was a hospital-based, observational study. As per protocol, anesthesiologists saw and diagnosed any patient exhibiting symptoms of CA, after which they initiated a preestablished treatment regimen. To examine the efficacy of this protocol between March 2007 and December 2011, the number of CAs anesthesiologists managed and time to treatment were recorded. Additionally, the frequency of CAs was established along with some of their risk factors. Results: Throughout the study period, there were 91,064 surgical cases, with 118 CAs (0.13% incidence). Anesthesiology alone managed 110 (93.22%) of these cases. The median time between the end of anesthesia to the time of prescribed ophthalmic medication was 156 minutes (first–third interquartile range: 108–219). All patients experienced resolution of symptoms by the morning following their complaint. Compared to the general surgical population, CA patients were older (P<0.01) and underwent longer surgeries (P<0.01). Conclusion: Minor CAs can be safely and effectively managed using an anesthesiology-based approach. Advanced age and longer surgery are confirmed as risk factors for these injuries. Keywords: corneal injuries, clinical protocols, patient care management, perioperative complications