Feasibility of day-case vitreoretinal surgery

Abstract

Purpose The indications for vitreoretinal (VR) surgery are increasing as equipment and techniques available improve. In order to decrease demand on limited health resources, day-case surgery would be beneficial in many cases. This study combines a retrospective and prospective arm to examine the feasibility and safety of routine day-case VR surgery. Methods One hundred consecutive patients (50 retrospective and 50 prospective) undergoing VR surgery within the Royal Berkshire NHS trust were included. The retrospective arm aimed to identify the frequency and type of acute ophthalmic or medical intervention during postop overnight stay and the results were used to alter management in the prospective group. The prospective group consisted of patients undergoing a mixture of overnight stay and day-case surgery. All patients in the prospective group had routine subtenon marcaine anaesthesia together with prophylactic pre-operative intravenous acetazolamide. Patients deemed fit postoperatively were offered overnight ward discharge, with obligatory next-day review. Results In the retrospective arm, 56% required oral nonsteroidal analgesia on the day of surgery and one patient required narcotic analgesia. Twenty-two per cent patients required intraocular pressure (IOP) control on the day of surgery and one patient required medical intervention in the form of urinary catheterisation. Nineteen patients required intervention on next-day review. In the prospective arm, 86% preferred day case and were suitable, 6% were suitable for day-case but preferred overnight stay and 8% were deemed not fit for discharge. No patient required narcotic analgesics. No patient discharged returned as a casualty overnight. Only one patient required topical beta-blocker for the control of IOP on next-day review.Conclusions These data suggest that many patients who are hospitalised overnight for VR surgery could be safely treated as day cases. Such a shift in the pattern of care for VR surgery could provide a significant improvement in health-care efficiency and minimise patient inconvenience.

Incidence of early complications requiring treatment plan changes after vitreoretinal surgery: a single-center study in South Korea

“…The previously reported types and incidence of postoperative complications in patients who had undergone vitreoretinal surgery are summarized in Table 5 . The incidence of postoperative complications reported in our study were generally lower than those reportedly [ 5 – 25 ]. However, this study only analyzed cases where treatment plan changes were deemed necessary.…”

National Survey of Day-Case Vitreoretinal Surgery in the United Kingdom

“…A number of studies have shown the efficacy of local/sub-Tenon anesthesia for vitreoretinal procedures with respect to perioperative pain; however, there was often a need for the use of additional agents/sedatives (sub-Tenon or intravenous, respectively) by the attending anesthetist for more lengthy and complicated procedures such as repeat procedures and scleral buckling (6)(7)(8). There is evidence to show that local vs general anesthesia for vitreoretinal surgery does not influence the final anatomic/ visual outcome or intraoperative and postoperative complication rates (2,3) and that local/sub-Tenon anesthesia are well-tolerated by patients (1,5). Small-gauge vitrectomy has become increasingly popular in recent years, though its true benefits remain a subject of debate.…”

Unplanned readmission after ocular trauma ambulatory surgery: A retrospective study of the Zhongshan Ophthalmic Center

“…Unplanned readmission is an important indicator of the quality of care for ocular trauma patients. Several studies have surveyed the rate of unplanned readmission after AS . In a study on ambulatory sino‐nasal surgeries conducted in New York, Florida, Iowa, and California in 2010, 5% of the patients were found to revisit after surgery, of which 18.9% revisited the AS centre, 67% the emergency department, and 14.1% had inpatient admission .…”

“…However, no study has evaluated the unplanned readmission rate after ophthalmological AS. Existing studies on vitreoretinal AS are focused on postoperative pain or raised intraocular pressure (IOP), travelling distances, patient choice, and the demand of posturing after AS . Our study focused on the index of the 31‐day unplanned readmission rate, which reflects the occurrence of more severe cases postoperative complications.…”