Abstract
Objective This article evaluates the effectiveness of an ophthalmology resident-led quality
improvement (QI) initiative to decrease the incidence of perioperative corneal injury
at an academic medical center
Design Retrospective chart review.
Methods A retrospective chart review was conducted of all surgical cases performed 6 months
prior to, and 6 months after, implementation of an ophthalmology resident-led QI initiative
at an academic medical center. The QI initiative (which focused on perioperative corneal
injury awareness, understanding of risk factors, and presentation of an algorithm
designed to prevent perioperative corneal injury) consisted of a lecture and distribution
of educational materials to anesthesia providers. Data collected through the chart
review included type of surgical case, presence of diabetes mellitus or thyroid disease,
patient age and gender, patient positioning (supine, prone, or lateral), level of
anesthesia provider training, length of surgical case, surgical service, type of anesthesia,
and type (if any) of perioperative eye injury. The rates of perioperative corneal
injury pre- versus post-initiative were compared.
Results The rates of perioperative corneal injury pre- and post-initiative were 3.7 and 1.9
per 1,000, respectively (p = 0.012). Significant risk factors for perioperative corneal injury include longer
duration of surgery (odds ratio [OR] 90–180 vs. < 90 minutes = 4.18, 95% confidence
interval [CI] 1.43–12.18; OR > 180 vs. < 90 minutes = 8.56, 95% CI 3.01–24.32; OR > 180
vs. 90–180 = 2.05, 95% CI 1.17–3.58), patient position lateral > prone > supine (OR
prone vs. lateral = 0.25, 95% CI 0.09–0.67; OR supine vs. lateral = 0.13, 95% CI 0.07–0.23),
nonhead and neck surgeries (OR = 0.32, 95% CI 0.11–0.87), and surgery performed under
the general surgery service (OR general surgery service vs. other subspecialty services = 6.50,
95% CI 2.39–24.76).
Conclusions An ophthalmology resident-led QI initiative consisting of educating anesthesia providers
was associated with a significant decrease in the rate of perioperative corneal injury.
Keywords
perioperative corneal injury - corneal abrasion - exposure keratopathy - quality improvement
initiative
