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Khodakovsky M. Regional anesthesia in ophthalmic surgery (overview of the problem). PAIN MEDICINE 2022. [DOI: 10.31636/pmjua.v6i4.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The article is devoted to the optimization of anesthetic management using regional methods of anesthesia in ophthalmic surgery. Methods and techniques of anesthetic management provide a sufficient level of anesthetic protection. All variants of regional anesthesia (monocomponent and combined) are used in the ophthalmological clinic “Optimal” on the basis of the Department of Anesthesiology, Intensive Care and Emergency Medicine of National Pirogov Memorial Medical University, Vinnytsia.
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Cillino S, Iggui A, Di Naro S, Cillino G, Matranga D, Mazzucco W, Pojero F, Casuccio A. Determinants of inappropriate hospitalization in cataract surgery in the south of Italy: a retrospective study. Int Ophthalmol 2018. [PMID: 29520514 DOI: 10.1007/s10792-018-0887-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To analyze the frequency of inappropriate hospitalization in cataract surgery and the type of related determinants. METHODS A nested retrospective case-control study was carried out on 2708 consecutive cataract surgery patients operated between January 2013 and December 2015. All cases with inappropriate hospitalization (day surgery or ordinary hospitalization) were compared with a control group of cases treated in an appropriate (day service) regimen. The predictive value for inappropriate admissions to the hospital was assessed using a logistic regression model. Significant variables from the univariate analysis were included in a multivariate model. RESULTS Forty-five cases (< 2%) of inappropriate hospital admissions were recorded. Residence, heart disease, tremors, anticoagulants, intraoperative floppy iris syndrome were not related to appropriateness, while psychotic disorder (OR 12.571, p = 0.018), anxiety-depressive syndrome (OR 7.818, p = 0.010) and use of antipsychotropic drugs (OR 7.724, p = 0.002) were related to the inappropriateness of admission by univariate and multivariate analysis. Previous systemic surgeries were predictors of ordinary hospitalization by logistic regression analysis. A greater presence of hypertension, diabetes mellitus and fellow eye pseudophakia was noticed in appropriate hospitalization cases. CONCLUSIONS This study detects the predictive role of psychiatric disorders as determinants of hospitalization inappropriateness in cataract surgery. The negative correlation between inappropriate hospitalization and conditions such as hypertension and diabetes points out that in the elderly population common diseases are effectively addressed, in contrast to the difficult management of psychiatric patients. Prior systemic interventions represent factors inducing transfer from day service to ordinary hospitalization, highlighting communication problems related to difficult coping with an outpatient surgery setting.
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Affiliation(s)
- Salvatore Cillino
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section, University of Palermo, via Liborio Giuffrè, 13, 90127, Palermo, Italy.
| | - Aissa Iggui
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section, University of Palermo, via Liborio Giuffrè, 13, 90127, Palermo, Italy
| | - Simona Di Naro
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section, University of Palermo, via Liborio Giuffrè, 13, 90127, Palermo, Italy
| | - Giovanni Cillino
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section, University of Palermo, via Liborio Giuffrè, 13, 90127, Palermo, Italy
| | - Domenica Matranga
- Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", University of Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Walter Mazzucco
- Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", University of Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Fanny Pojero
- Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", University of Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Alessandra Casuccio
- Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", University of Palermo, Via del Vespro 127, 90127, Palermo, Italy
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Gianino MM, Lenzi J, Bonaudo M, Fantini MP, Siliquini R, Ricciardi W, Damiani G. The switch between cataract surgical settings: Evidence from a time series analysis across 20 EU countries. PLoS One 2018; 13:e0192620. [PMID: 29489834 PMCID: PMC5831096 DOI: 10.1371/journal.pone.0192620] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 01/27/2018] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To analyze trajectories of cataract surgery rates and to confirm the switch between inpatient cases and day surgery or outpatient cases. DESIGN Pooled, cross-sectional, time series analysis. METHODS Data on 20 European countries from 2004 to 2014 retrieved from the OECD. RESULTS The number of cataract surgery cases per 100,000 population has increased since 2004 (b = 31.1, p < 0.001, 95% CI = 26.7, 35.6). A reversal of the inpatient cases and same-day cases was found: the first ones decreased (b = -14.7, p < 0.001, 95% CI = -17.7, -11.8) while day surgery and outpatient cases increased (b = 37.5, p < 0.001, 95% CI = 31.6, 43.4, and b = 8.3, p = 0.001, 95% CI = 3.6, 13.1, respectively). Since 2004, the ratio of day surgery and outpatient cases to inpatient cases has grown significantly (b = 3.3, p < 0.001, 95% CI = 2.5, 4.0), reaching a share of 31.7 in 2014. However, this slope of 3.3 was not constant and slowed over the years: from 4.5 per year during the first five years to 1.9 in the second five. No association was found between cataract surgery rate and two regressors: elderly people, and health care expenditure per capita. CONCLUSION EU countries have preserved cataract surgery, and this preservation is probably affected by the switch from inpatient to same-day surgery, thanks to the decrease in the cost and equivalent clinical outcomes. However, the slope of the switch slowed over time. Consequently, health care systems must support this process of change especially through reforms in financial and organizational fields.
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Affiliation(s)
- Maria Michela Gianino
- Department of Public Health Sciences and Pediatrics, Università di Torino, Turin, Italy
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum–Università di Bologna, Bologna, Italy
| | - Marco Bonaudo
- Department of Public Health Sciences and Pediatrics, Università di Torino, Turin, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum–Università di Bologna, Bologna, Italy
| | - Roberta Siliquini
- Department of Public Health Sciences and Pediatrics, Università di Torino, Turin, Italy
| | - Walter Ricciardi
- Department of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gianfranco Damiani
- Department of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
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More frequent requests for day-case cataract surgery : An impressive mind switch in the Austrian population within 7 years. Wien Med Wochenschr 2017; 167:314-319. [PMID: 28357522 DOI: 10.1007/s10354-017-0554-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 02/20/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Cataract surgery is the most commonly performed elective surgical procedure worldwide. While the operation has been mainly conducted as day-case (outpatient) surgery throughout the world since the beginning of this millennium, this development has been much slower in Austria. The number of patients requesting day-case surgery has markedly increased in the last few years. METHODS Prior to the introduction of a day clinic at our department in 2007, we evaluated the patients' acceptance of day-case surgery using a questionnaire. At the time, less than half of the patients wished to undergo day-case surgery. Another survey was performed 7 years later to determine if there were any changes. RESULTS The desire for day-case surgery increased significantly from 38.8 to 87.1%. The mean age of the patients and their visual impairment had decreased. Home care improved, but not to the same extent. The number of patients who had to travel more than an hour to reach the hospital had significantly increased. CONCLUSIONS Improvements in perioperative limitations and most of all patients becoming accustomed to the idea have led to an impressive mind switch, culminating in a clear desire for day-case cataract surgery.
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Usefulness of surgical complexity classification index in cataract surgery process. ACTA ACUST UNITED AC 2016; 91:281-7. [PMID: 26897332 DOI: 10.1016/j.oftal.2016.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 12/18/2015] [Accepted: 01/04/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the usefulness of surgical complexity classification index (SCCI) to predict the degree of surgical difficulty in cataract surgery. MATERIAL AND METHODS This retrospective study includes data collected between January 2013 and December 2014 from patients who underwent cataract extraction by phacoemulsification at our hospital. A sample size of 159 patients was obtained by simple random sampling (P=.5, 10% accuracy, 95% confidence). The main variables were: recording and value of SCCI in electronic medical record (EMR), presence of exfoliation syndrome (XFS), criteria for inclusion in surgical waiting list (SWL), and functional results. SCCI was classified into 7 categories (range: 1-4) according to predictors of technical difficulty, which was indirectly estimated in terms of surgical time (ST). All statistical analyses were performed using SPSS v15.0 statistical software. RESULTS Prevalence of XFS was 18.2% (95%CI: 11.9-24.5). In terms of quality indicators in the cataract surgery process, 96.8% of patients met at least one of the criteria to be included in SWL, and 98.1% gained ≥2 Snellen lines. The SCCI was recorded in EMR of 98.1% patients, and it was grouped for study into 2 categories: High and low surgical complexity. Statistically significant differences in the distribution of ST were found depending on the assigned SCCI (P<.005) and the presence of XFS (P<.005). CONCLUSIONS The SCCI enables to estimate the degree of surgical complexity in terms of ST in cataract surgery, which is especially useful in those areas with high prevalence of XFS, because of the higher theoretical risk of surgical complications.
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Abstract
BACKGROUND Age-related cataract accounts for more than 40% of cases of blindness in the world with the majority of people who are blind from cataract living in lower income countries. With the increased number of people with cataract, it is important to review the evidence on the effectiveness of day care cataract surgery. OBJECTIVES To provide authoritative, reliable evidence regarding the safety, feasibility, effectiveness and cost-effectiveness of day case cataract extraction by comparing clinical outcomes, cost-effectiveness, patient satisfaction or a combination of these in cataract operations performed in day care versus in-patient units. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2015, Issue 7), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to August 2015), EMBASE (January 1980 to August 2015), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to August 2015), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 17 August 2015. SELECTION CRITERIA We included randomised controlled trials comparing day care and in-patient surgery for age-related cataract. The primary outcome was the achievement of a satisfactory visual acuity six weeks after the operation. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. We contacted study authors for additional information. We collected adverse effects information from the trials. MAIN RESULTS We included two trials. One study was conducted in the USA in 1981 (250 people randomised and completed trial) and one study conducted in Spain in 2001 (1034 randomised, 935 completed trial). Both trials used extracapsular cataract extraction techniques that are not commonly used in higher income countries now. Most of the data in this review came from the larger trial, which we judged to be at low risk of bias.The mean change in visual acuity (in Snellen lines) of the operated eye four months postoperatively was similar in people given day care surgery (mean 4.1 lines standard deviation (SD) 2.3, 464 participants) compared to people treated as in-patients (mean 4.1 lines, SD 2.2, 471 participants) (P value = 0.74). No data were available from either study on intra-operative complications.Wound leakage, intraocular pressure (IOP) and corneal oedema were reported in the first day postoperatively and at four months after surgery. There was an increased risk of high IOP in the day care group in the first day after surgery (risk ratio (RR) 3.33, 95% confidence intervals (CI) 1.21 to 9.16, 935 participants) but not at four months (RR 0.61, 95% CI 0.14 to 2.55, 935 participants). The findings for the other outcomes were inconclusive with wide CIs. There were two cases of endophthalmitis observed at four months in the day care group and none in the in-patient group. The smaller study stated that there were no infections or severe hyphaemas.In a subset of participants evaluated for quality of life (VF14 questionnaire) similar change in quality of life before and four months after surgery was observed (mean change in VF14 score: day care group 25.2, SD 21.2, 150 participants; in-patient group: 23.5, SD 25.7, 155 participants; P value = 0.30). Subjective assessment of patient satisfaction in the smaller study suggested that participants preferred to recuperate at home, were more comfortable in their familiar surroundings and enjoyed the family support that they received at home. Costs were 20% more for the in-patient group and this was attributed to higher costs for overnight stay. AUTHORS' CONCLUSIONS This review provides evidence that there is cost saving with day care cataract surgery compared to in-patient cataract surgery. Although effects on visual acuity and quality of life appeared similar, the evidence with respect to postoperative complications was inconclusive because the effect estimates were imprecise. Given the wide-spread adoption of day care cataract surgery, future research in cataract clinical pathways should focus on evidence provided by high quality clinical databases (registers), which would enable clinicians and healthcare planners to agree clinical and social indications for in-patient care and so make better use of resources.
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Affiliation(s)
- David Lawrence
- London School of Hygiene & Tropical MedicineKeppel StreetLondonUKWC1E 7HT
| | | | - Esther J van Zuuren
- Leiden University Medical CenterDepartment of DermatologyPO Box 9600B1‐QLeidenNetherlands2300 RC
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Wang X, Hawkins BS, Dickersin K. Cochrane systematic reviews and co-publication: dissemination of evidence on interventions for ophthalmic conditions. Syst Rev 2015; 4:118. [PMID: 26395078 PMCID: PMC4580360 DOI: 10.1186/s13643-015-0104-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 08/24/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Systematic reviews of interventions provide a summary of the evidence available on intervention effectiveness and harm. Cochrane systematic reviews (CSRs) have been published electronically in the Cochrane Database of Systematic Reviews (CDSR) since 1994, and co-publication (publication of a Cochrane review in another journal) has been allowed since that time, as long as the co-publishing journal has agreed to the arrangement. Although standards for co-publication were established in 2008, the frequency of co-publication and adherence to the standards have remained largely unexamined. Our objective was to examine the frequency of co-publication of Cochrane Eyes and Vision Group (CEVG) reviews, adherence to the co-publication policy, the relative numbers of citations of the two modes of publishing, and differences in times cited in CSRs with and without a co-publication. METHODS We identified all CEVG reviews published by May 30, 2014 in The Cochrane Library. Using keywords from the title, author names, and "Cochrane Eyes and Vision Group", we searched Google Scholar, Web of Science, Scopus, and PubMed databases to identify possible co-publications. We also emailed contact authors of all identified CEVG reviews to ask them whether they had published their CSR elsewhere. We compared each co-publication to the corresponding CEVG review for adherence to the Cochrane Policy Manual (dated June 10, 2014). We recorded the number of times each CEVG review and each co-publication had been cited by others according to Google Scholar, Web of Science, and Scopus, as of June 11, 2014. RESULTS We identified 117 CEVG reviews;19 had been co-published in 22 articles. Adherence to Cochrane policy on co-publication was moderate, with all authors complying with at least one of four requirements we addressed. Co-publications were cited more often than the corresponding CEVG reviews; CEVG reviews with at least one co-publication were cited approximately twice as often as CEVG reviews without a co-publication. The number of citations varied considerably depending on whether the CEVG review had a co-publication or not. CONCLUSIONS The findings support encouraging co-publication while maintaining the primacy of the Cochrane systematic review. Support for co-publication may be tempered by other factors such as the possibility that CEVG reviews with a co-publication covered more clinically important and timely topics than those without a co-publication. Assuming that citations are a valid measure of dissemination effectiveness, the 15-year CEVG experience with co-publication of systematic reviews suggests that Cochrane authors should be encouraged to co-publish in traditional medical journals.
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Affiliation(s)
- Xue Wang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Md, 21205, USA.
| | - Barbara S Hawkins
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Md, 21205, USA.
- The Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Md, 21287, USA.
| | - Kay Dickersin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Md, 21205, USA.
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Davis JC, McNeill H, Wasdell M, Chunick S, Bryan S. Focussing both eyes on health outcomes: revisiting cataract surgery. BMC Geriatr 2012; 12:50. [PMID: 22943071 PMCID: PMC3497611 DOI: 10.1186/1471-2318-12-50] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 08/27/2012] [Indexed: 11/18/2022] Open
Abstract
Background The appropriateness of cataract surgery procedures has been questioned, the suggestion being that the surgery is sometimes undertaken too early in the disease progression. Our three study questions were: What is the level of visual impairment in patients scheduled for cataract surgery? What is the improvement following surgery? Given the thresholds for a minimal detectable change (MDC) and a minimal clinically important difference (MCID), do gains in visual function reach the MDC and MCID thresholds? Methods The sample included a prospective cohort of cataract surgery patients from four Fraser Health Authority ophthalmologists. Visual function (VF-14) was assessed pre-operatively and at seven weeks post-operatively. Two groups from this cohort were included in this analysis: ‘all first eyes’ (cataract extraction on first eye) and ‘both eyes’ (cataract removed from both eyes). Descriptive statistics, change scores for VF-14 for each eye group and proportion of patients who reach the MDC and MCID are reported. Results One hundred and forty-two patients are included in the ‘all first eyes’ analyses and 55 in the ‘both eyes’ analyses. The mean pre-operative VF-14 score for the ‘all first eyes’ group was 86.7 (on a 0–100 scale where 100 is full visual function). The mean change in VF-14 for the 'both eyes' group was 7.5. Twenty-three percent of patients achieved improvements in visual function beyond the MCID threshold and 35% saw improvement beyond the MDC. Conclusions Neither threshold level for MDC or MCID for the VF-14 scale was achieved for a majority of patients. A plausible explanation for this is the very high levels of pre-operative visual functioning.
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Affiliation(s)
- Jennifer C Davis
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada.
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Fedorowicz Z, Lawrence D, Gutierrez P, van Zuuren EJ. Day care versus in-patient surgery for age-related cataract. Cochrane Database Syst Rev 2011:CD004242. [PMID: 21735397 DOI: 10.1002/14651858.cd004242.pub4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Age-related cataract accounts for more than 40% of cases of blindness in the world with the majority of people who are blind from cataract found in the developing world. With the increased number of people with cataract there is an urgent need for cataract surgery to be made available as a day care procedure. OBJECTIVES To provide reliable evidence for the safety, feasibility, effectiveness and cost-effectiveness of cataract extraction performed as day care versus in-patient procedure. SEARCH STRATEGY We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2011, Issue 5), MEDLINE (January 1950 to May 2011), EMBASE (January 1980 to May 2011), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to May 2011), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) and ClinicalTrials.gov (www.clinicaltrials.gov). There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 23 May 2011. SELECTION CRITERIA We included randomised controlled trials comparing day care and in-patient surgery for age-related cataract. The primary outcome was the achievement of a satisfactory visual acuity six weeks after the operation. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information. Adverse effects information was collected from the trials. MAIN RESULTS We included two trials (conducted in Spain and USA), involving 1284 people. One trial reported statistically significant differences in early postoperative complication rates in the day care group, with an increased risk of increased intraocular pressure, which had no clinical relevance to visual outcomes four months postoperatively. The mean change in visual acuity (Snellen lines) of the operated eye four months postoperatively was 4.1 (standard deviation (SD) 2.3) for the day care group and 4.1 (SD 2.2) for the in-patient group and not statistically significant. The four-month postoperative mean change in quality of life score measured using the VF14 showed minimal differences between the two groups. Costs were 20% more for the in-patient group and this was attributed to higher costs for overnight stay. One study only reported hotel costs for the non-hospitalised participants making aggregation of data on costs impossible. AUTHORS' CONCLUSIONS This review provides some evidence that there is a cost saving but no significant difference in outcome or risk of postoperative complications between day care and in-patient cataract surgery. This is based on one detailed and methodologically sound trial conducted in the developed world. The success, safety and cost-effectiveness of cataract surgery as a day care procedure appear to be acceptable. Future research may well focus on evidence provided by high quality clinical databases and registers which would enable clinicians and healthcare planners to agree clinical and social indications for in-patient care and so make better use of resources, by selecting day case surgery unless these criteria are met.
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Affiliation(s)
- Zbys Fedorowicz
- UKCC (Bahrain Branch), Ministry of Health, Bahrain, Box 25438, Awali, Bahrain
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Kohnen T, Baumeister M, Kook D, Klaproth OK, Ohrloff C. Cataract surgery with implantation of an artificial lens. DEUTSCHES ARZTEBLATT INTERNATIONAL 2009; 106:695-702. [PMID: 19946433 DOI: 10.3238/arztebl.2009.0695] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Accepted: 04/08/2009] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cataract surgery, the most frequently performed operative procedure worldwide, typically concludes with the implantation of an artificial intraocular lens (IOL) to correct aphakia (absence of the crystalline lens). METHOD Selective literature review including current regulations, guidelines and recommendations for cataract surgery. RESULTS The main symptom of cataract is loss of visual acuity, which usually progresses slowly. It can arise in one eye or both. There is a basic distinction between congenital and acquired cataracts. The probability of developing a cataract rises with age because of biochemical aging processes. The development of a cataract becomes highly likely from the sixth decade of life onward. CONCLUSIONS As no effective medications for cataract are available at present, its current standard treatment is the removal of the clouded lens. In industrialized countries, this is usually done with ultrasound (phacoemulsification), followed by the implantation of an IOL.
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Affiliation(s)
- Thomas Kohnen
- Klinik für Augenheilkunde, Goethe-Universität, Frankfurt am Main.
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Prakash G, Sharma N, Jhanji V, Agarwal T, Titiyal JS. Impact of day care cataract surgery on inpatient services in a tertiary care ophthalmic setup. Trop Doct 2009; 39:141-4. [PMID: 19535747 DOI: 10.1258/td.2008.080125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We retrospectively reviewed the admission patterns for one year before and one year after the introduction of day care cataract surgery at our cornea services and noted that the number of cataract surgeries per month improved from year 2003 to 2005 (P < 0.001), with a higher number of admissions for non-emergency corneal pathology seen in 2005 (P < 0.001). There was a 69.1% more chance of admission for a corneal pathology patient after the introduction of day care services cataract surgery. Day care cataract surgery decongests non-cataract pathology related inpatient services and is therefore a viable alternative in the developing world.
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Affiliation(s)
- Gaurav Prakash
- Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110029, India.
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Is day-case cataract surgery an attractive alternative from the patients' point of view? A questionnaire survey. Wien Klin Wochenschr 2009; 120:756-60. [PMID: 19122987 DOI: 10.1007/s00508-008-1113-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2008] [Accepted: 10/19/2008] [Indexed: 10/21/2022]
Abstract
Cataract surgery is the most common elective surgical procedure undertaken in elderly people. In many European countries and in the USA cataract surgery is normally a day-case procedure without an overnight stay in hospital, unlike the situation in Austria where fewer than 2% of patients are day cases. However, there is a lack of prospective studies on patients' need for and acceptance of day-case surgery. The aim of our study was therefore to evaluate patients' demand and suitability for outpatient surgery, based on analysis of preoperative questionnaires on availability of family and/or social support and on preoperative ophthalmologic examination. Among 500 consecutive patients with cataract, 154 (41.8%) chose a day-case procedure and 256 (58.2%) preferred inpatient admission. Patients preferring full admission were older (mean age 76.4+/-8.1 vs. 72.73+/-9.5 years, P<0.001), had worse visual acuity (0.55+/-0.20 vs. 0.66+/-0.23, P<0.001), were more likely to be female (63.9% vs. 47.0%, P=0.001), to live more than one hour away from the hospital (26.5% vs. 12.5%, P<0.001) and have no carer at home (43.0% vs. 6.5%, P<0.001). Patients favoring day-case surgery were more likely to be able to attend an ophthalmologic check-up 24 h after surgery (96.7% vs. 59.6%, p<0.001). The majority of patients indicated a preference for inpatient care, but this may be a reflection of their previous hospital experience and a matter of custom in the elderly population. Information, education and better organization of after-surgery services could help increase the attractiveness of cataract surgery as an outpatient procedure in Austria. Our findings could also be relevant to day-case services in medical care in general.
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Weingessel B, Richter-Mueksch S, Weingessel A, Gnad H, Vécsei-Marlovits PV. Tagesklinische Katarakt-Chirurgie – attraktiv für PatientInnen? SPEKTRUM DER AUGENHEILKUNDE 2008. [DOI: 10.1007/s00717-008-0249-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Suhonen R, Virtanen H, Heikkinen K, Johansson K, Kaljonen A, Leppänen T, Salanterä S, Leino-Kilpi H. Health-related quality of life of day-case surgery patients: a pre/posttest survey using the EuroQoL-5D. Qual Life Res 2007; 17:169-77. [PMID: 18074242 DOI: 10.1007/s11136-007-9292-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2007] [Accepted: 11/22/2007] [Indexed: 10/22/2022]
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Abstract
This study describes the health-related quality of life (HRQoL) of day-surgery patients and aims to identify factors associated with HRQoL. The cross-sectional questionnaire survey data were collected from day-surgery patients being discharged from hospitals in one Finnish hospital district in 2001 using the Nottingham Health Profile (NHP). The analysis was based on statistical methods. Day-case surgical patients had the best HRQoL in the social dimension and mobility. The NHP scores showed moderate distress in sleep and energy, and demonstrated pain. Older age and vocational education were associated with higher scores as measured with the NHP, indicating more problems in the measured variables. The patients who have been operated as day cases recovered satisfactorily and the operation did not weaken their perceived HRQoL. More emphasis should be put on evaluating day-case surgery patients' pain. Patient's age should be taken into account in planning type of surgery. The NHP is also a useful tool for the purposes of studying the HRQoL of day-case surgery patients.
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Affiliation(s)
- Riitta A Suhonen
- Quality and Development Manager, Health Care District of Forssa, Forssa, Finland.
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16
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Mojon-Azzi SM, Mojon DS. The rate of outpatient cataract surgery in ten European countries: an analysis using data from the SHARE survey. Graefes Arch Clin Exp Ophthalmol 2007; 245:1041-4. [PMID: 17318563 DOI: 10.1007/s00417-007-0550-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2006] [Revised: 01/21/2007] [Accepted: 01/26/2007] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The aim of this study was to determine the rates of outpatient cataract surgery (ROCS) in ten European countries and to find country-specific health indicators explaining the differences. METHODS Using data from the Survey of Health, Ageing and Retirement in Europe (SHARE), 251 eligible respondents were identified for which cataract surgery was the last surgical procedure. The ROCS of ten countries were compared using logistic regression. The influence of the public expenditure on health as per cent of the total expenditure on health, of the number of acute care beds per 1,000 population, and of the number of practicing physicians per 1,000 population, was studied by multiple logistic regression. Additional information was obtained from country-specific opinion leaders in the field of cataract surgery. RESULTS The ROCS differed significantly between the ten analysed European countries where Denmark had the highest (100%) and Austria the lowest (0%) rate of day care surgery. A decrease in the density of acute care beds (p < 0.0000001) and in the density of practicing physicians (p < 0.05) and an increase in the public expenditure on health as per cent of the total health expenditure (p < 0.01) lead to an increase in the ROCS. According to the opinion leaders, regulations and financial incentives also have a strong influence on the ROCS. CONCLUSIONS The outpatient rate of cataract surgery in the ten European countries was mainly influenced by the acute-care beds density, but also by the density of practicing physicians, and by the public expenditure on health.
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Affiliation(s)
- S M Mojon-Azzi
- Research Institute for Labour Economics and Labour Law, University of St. Gallen, St. Gallen, Switzerland.
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17
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Cillino S, Casuccio A, Di Pace F, Pillitteri F, Cillino G, Lodato G. Day care cataract surgery in Central and Southern Italy: a multicentric survey. BMC Health Serv Res 2007; 7:16. [PMID: 17270040 PMCID: PMC1797011 DOI: 10.1186/1472-6963-7-16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2006] [Accepted: 02/01/2007] [Indexed: 11/25/2022] Open
Abstract
Background Cataract day surgery has rapidly gained worldwide acceptance, because the new surgical techniques and costs are generally lower than those involved in ordinary hospitalization. Cataract surgery serves as a proxy indicator of the trend towards day surgery hospitalization in Italy and, therefore, of regional variability in health-care delivery and cost. The aim of this study was to update the diffusion of cataract day surgery through various surgical ophthalmological centers in central and southern Italy during 2005. Methods A two-stage stratified cluster sampling method was used to draw a sample of Cataract Surgery Unit from Ophthalmic Units of central and southern Italy. A questionnaire was sent to 25 cataract surgery centers in nine health districts that represented the range of establishments (public, private, accredited or otherwise) in which cataract surgery is performed. Data were collected on numbers of procedures performed in 2005, hospital admission type, time from the onset of cataract day surgery, surgical procedure, and presence of other surgical centers. Results The response rate was 42% (10 surveys), resulting in at least one completed questionnaire for each of these 9 districts. There is a positive trend towards day surgery hospitalization in all surgical centers. The percentage of patients treated as outpatients during 2005 varied from 50–60% (Avellino, Naples, Campobasso), to 80–90% (Rome, Bari), up to 90–100% (Catania, Palermo, Siracusa and Trapani), with an increasing trend in all the centers studied. Few differences were found in surgical procedures, and these were statistically insignificant. Conclusion Our results confirm a positive trend towards day surgery in place of hospital inpatient admission for cataract surgery. This trend is expected to close the existing regional gap in Italy. Increased efficiency is an overriding need for the National Health Service in order to improve the rationalization of resources.
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Affiliation(s)
- Salvatore Cillino
- Department of Clinical Neuroscience, Section of Ophthalmology, University of Palermo (Italy), via Liborio Giuffrè, 13 – 90127 Palermo, Italy
| | - Alessandra Casuccio
- Department of Clinical Neuroscience, Section of Ophthalmology, University of Palermo (Italy), via Liborio Giuffrè, 13 – 90127 Palermo, Italy
| | - Francesco Di Pace
- Department of Clinical Neuroscience, Section of Ophthalmology, University of Palermo (Italy), via Liborio Giuffrè, 13 – 90127 Palermo, Italy
| | - Francesco Pillitteri
- Department of Clinical Neuroscience, Section of Ophthalmology, University of Palermo (Italy), via Liborio Giuffrè, 13 – 90127 Palermo, Italy
| | - Giovanni Cillino
- Department of Clinical Neuroscience, Section of Ophthalmology, University of Palermo (Italy), via Liborio Giuffrè, 13 – 90127 Palermo, Italy
| | - Gaetano Lodato
- Department of Clinical Neuroscience, Section of Ophthalmology, University of Palermo (Italy), via Liborio Giuffrè, 13 – 90127 Palermo, Italy
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