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Forte PA, Brousset G, Varenne F, Fournié P, Soler V, Pagot-Mathis V. [Limitations of outpatient vitreoretinal surgery at the Toulouse University hospital between 2016 and 2020: Causes for traditional hospitalization]. J Fr Ophtalmol 2023; 46:908-915. [PMID: 37625994 DOI: 10.1016/j.jfo.2023.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 03/31/2023] [Indexed: 08/27/2023]
Abstract
INTRODUCTION Currently, the majority of patients undergoing vitreoretinal surgery (VRS) are managed on an outpatient basis; this has been made possible by major surgical and anesthetic advances over the past decades. Nevertheless, the conversion to "all outpatient" surgery still poses some problems that are interesting to identify, and traditional hospitalization remains the solution in many situations. METHODS All patients undergoing VRS at the Toulouse University Hospital between 2016 and 2020 were included retrospectively. For each patient, we analyzed the entire medical, anesthesia and demographic records. We performed a simple descriptive analysis of all parameters studied, followed by a bi-variate analysis between the "Outpatient/Hospitalization" parameter and all other parameters. RESULTS Three thousand patients were included over the study period; 79.4% of patients were managed on an outpatient basis compared to 20.6% by traditional hospitalization. Failure of ambulatory care was the cause of 41.9% of the traditional hospitalizations, with the absence of an accompanying person on the evening of the surgery being the main reason (47.8%). DISCUSSION Social isolation is found to be one of the main causes of failure of ambulatory care; improvements might be made at this level, in order to reduce the burden on the inpatient hospital system.
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Affiliation(s)
- P-A Forte
- Service ophtalmologie, unité rétine, CHU de Toulouse Purpan, place du Docteur-Baylac, 31059 Toulouse, France.
| | - G Brousset
- Service ophtalmologie, unité rétine, CHU de Toulouse Purpan, place du Docteur-Baylac, 31059 Toulouse, France
| | - F Varenne
- Service ophtalmologie, unité rétine, CHU de Toulouse Purpan, place du Docteur-Baylac, 31059 Toulouse, France
| | - P Fournié
- Service ophtalmologie, unité rétine, CHU de Toulouse Purpan, place du Docteur-Baylac, 31059 Toulouse, France
| | - V Soler
- Service ophtalmologie, unité rétine, CHU de Toulouse Purpan, place du Docteur-Baylac, 31059 Toulouse, France
| | - V Pagot-Mathis
- Service ophtalmologie, unité rétine, CHU de Toulouse Purpan, place du Docteur-Baylac, 31059 Toulouse, France
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Ben Ghezala I, Mariet AS, Benzenine E, Gabrielle PH, Baudin F, Quantin C, Creuzot-Garcher C. Incidence of rhegmatogenous retinal detachment following macular surgery in France between 2006 and 2016. Am J Ophthalmol 2022; 243:91-97. [PMID: 35907474 DOI: 10.1016/j.ajo.2022.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/07/2022] [Accepted: 07/15/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the incidence of postoperative rhegmatogenous retinal detachment after macular surgery in France between 2006 and 2016 and identify associated factors. DESIGN Nationwide population-based cohort study. METHODS All surgical procedures for an epiretinal membrane or a macular hole performed in France from January 1, 2006 to October 31, 2016 were identified in the French national administrative database (Programme de Médicalisation des Systèmes d'Information). We investigated the incidence of rhegmatogenous retinal detachment occurring within 90 days of a macular surgical procedure. RESULTS From January 1, 2006 to October 31, 2016, 152,034 macular surgical procedures for epiretinal membranes or macular holes were recorded in France. We identified 3,605 cases of rhegmatogenous retinal detachment occurring within 90 days of the procedure. The incidence of rhegmatogenous retinal detachment was 2.37% overall, 1.95% for epiretinal membrane surgery and 3.43% for macular hole surgery. In multivariable Poisson regression analysis, rhegmatogenous retinal detachment was associated with macular hole surgery (incidence rate ratio [IRR], 1.76; 95% CI, 1.63-1.90; P < .001), history of cataract extraction in the previous year (IRR, 1.20; 95% CI, 1.08-1.34; P = .001), age < 60 years (P < .001), and male gender (IRR, 1.63; 95% CI, 1.51-1.76; P < .001). CONCLUSIONS The incidence of rhegmatogenous retinal detachment within 90 days of macular surgery was 2.37% overall in France between 2006 and 2016 and it was higher for macular hole surgery than for epiretinal membrane surgery.
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Affiliation(s)
- Inès Ben Ghezala
- Ophthalmology Department, University Hospital, Dijon, France; Inserm, CIC 1432, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, University Hospital, Dijon, France
| | - Anne-Sophie Mariet
- Inserm, CIC 1432, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, University Hospital, Dijon, France; Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France, Bourgogne Franche-Comté University, Dijon, France; Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
| | - Eric Benzenine
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France, Bourgogne Franche-Comté University, Dijon, France
| | - Pierre-Henry Gabrielle
- Ophthalmology Department, University Hospital, Dijon, France; Eye and Nutrition Research Group, CSGA, UMR1324 INRAE, 6265 CNRS, Dijon, France
| | - Florian Baudin
- Ophthalmology Department, University Hospital, Dijon, France
| | - Catherine Quantin
- Inserm, CIC 1432, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, University Hospital, Dijon, France; Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France, Bourgogne Franche-Comté University, Dijon, France; Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
| | - Catherine Creuzot-Garcher
- Ophthalmology Department, University Hospital, Dijon, France; Eye and Nutrition Research Group, CSGA, UMR1324 INRAE, 6265 CNRS, Dijon, France
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Ma Q, Fan F, Zhao Z, Jia Z. Combined phacoemulsification, 23-gauge pars plana vitrectomy with internal limiting membrane peeling and gas tamponade for patients with coexisting idiopathic macular hole and age-associated cataract. Exp Ther Med 2019; 17:525-530. [PMID: 30651832 DOI: 10.3892/etm.2018.6963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 09/19/2018] [Indexed: 11/05/2022] Open
Abstract
The aim of the present study was to assess the curative effect of combined phacoemulsification, 23-gauge pars plana vitrectomy with Brilliant blue G-assisted limiting membrane peeling and gas tamponade in patients with coexisting idiopathic macular hole (IMH) and age-associated cataract. A total of 21 consecutive patients (21 eyes) with coexisting IMH and age-associated cataract were enrolled in the study. All patients were treated by 23-gauge microincision vitrectomy with internal limiting membrane peeling, gas tamponade and combined phacoemulsification. The pre-operative MH diameter, MH index and best-corrected visual acuity (BCVA), as well as events of post-operative MH closure and complications were recorded and analyzed. Anatomic closure of the MH was achieved in 19 eyes (90.4%) with a single surgery. The LogMAR BCVA value at 1 month after surgery and the final follow-up visit was significantly lower than the baseline value (P=0.0036 and P=0.0015, respectively). A significant correlation was identified between the MH index and the post-operative LogMAR BCVA (r=0.869; P<0.001). The combined technique applied in the present study produced favorable anatomic and functional results for patients with coexisting IMH and age-associated cataracts. The pre-operative MH size measured by optical coherence tomography may serve as a predictive factor for the LogMAR BCVA value following MH surgery.
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Affiliation(s)
- Qingmin Ma
- Department of Ophthalmology, Hebei General Hospital, Shijiazhuang, Hebei 050051, P.R. China
| | - Fang Fan
- Department of Ophthalmology, Hebei General Hospital, Shijiazhuang, Hebei 050051, P.R. China
| | - Zhihua Zhao
- Department of Ophthalmology, Hebei General Hospital, Shijiazhuang, Hebei 050051, P.R. China
| | - Zhiyang Jia
- Department of Ophthalmology, Hebei General Hospital, Shijiazhuang, Hebei 050051, P.R. China
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Bricout M, Feldman, Rochepeau C, Hafidi M, Labeille E, Cornut PL. [Outpatient vitreoretinal surgery without next-day examination: Feasibility and acceptability]. J Fr Ophtalmol 2018; 41:852-856. [PMID: 30342778 DOI: 10.1016/j.jfo.2018.01.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 01/15/2018] [Indexed: 11/15/2022]
Abstract
PURPOSE To assess the feasibility and acceptability of outpatient care without next-day examination for patients undergoing retinal surgery. METHODS Patients undergoing ambulatory vitreoretinal surgery between November 2013 and February 2016 at the Vienna medical center were included in this retrospective study. The age, comorbidities, indication, surgical technique and type of anesthesia used, symptoms, intraocular pressure and biomicroscopic examination data at the D0, D7 and M1 visits were recorded. Patient satisfaction with the outpatient treatment was collected by phone call in April 2016. RESULTS Fifty-three surgeries on 49 patients (24 women, 25 men) with a mean age of 70 years (range, 39-91 years) were analyzed. The surgery was pars plana vitrectomy in all cases, with 26 cases of epiretinal membrane surgery, 7 vitreomacular traction syndrome, 4 vitreous hemorrhage, 6 macular hole, 4 dislocation of lens material, 5 retinal detachment and 1 macular retinoschisis in high myopia. The type of anesthesia was general in 64.1 % of cases (34) and local in 36.9 % of cases (19). Of the D0 examination data, 100 % were compatible with the patient being discharged to home. One patient consulted before the D7 exam for the occurrence of a subconjunctival hemorrhage. There were seven cases (13.2 %) of intraocular pressure elevation and two cases of vitreous hemorrhage (3.8 %) on the D7 examination data. Twenty-seven patients (55.1 %) were reached by phone and all of them were satisfied with their outpatient management. CONCLUSION Outpatient treatment of patients without next-day examination for vitreoretinal surgery is possible and well accepted.
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Affiliation(s)
- M Bricout
- Centre hospitalier Lucien-Hussel-Vienne, montée du Dr Chapuis, 38200 Vienne, France
| | - Feldman
- Centre hospitalier Lucien-Hussel-Vienne, montée du Dr Chapuis, 38200 Vienne, France; Centre Leo, 140, rue André Lwoff, 69800 Saint-Priest, France
| | - C Rochepeau
- Centre hospitalier Lucien-Hussel-Vienne, montée du Dr Chapuis, 38200 Vienne, France
| | - M Hafidi
- Centre hospitalier Lucien-Hussel-Vienne, montée du Dr Chapuis, 38200 Vienne, France
| | - E Labeille
- Centre hospitalier Lucien-Hussel-Vienne, montée du Dr Chapuis, 38200 Vienne, France
| | - P-L Cornut
- Centre hospitalier Lucien-Hussel-Vienne, montée du Dr Chapuis, 38200 Vienne, France; Centre pôle vision Val d'Ouest, Clinique du Val d'Ouest, 39, chemin de-la-Vernique, 69130 Ecully, France.
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Cornut PL, Boujnah Y, Bezza Chellouai W, Marty AS, Beccat S, Boucher S, Burillon C. Évaluation de la faisabilité et de l’acceptabilité de la prise en charge en ambulatoire des patients opérés de décollement de rétine. J Fr Ophtalmol 2014; 37:23-9. [DOI: 10.1016/j.jfo.2013.05.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 05/15/2013] [Accepted: 05/17/2013] [Indexed: 10/26/2022]
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Cornut PL, Soldermann Y, Robin C, Barranco R, Kerhoas A, Burillon C. [Optimizing the financial impact of transitioning to transconjunctival vitrectomy and microincisional phacoemulsification]. J Fr Ophtalmol 2013; 36:843-51. [PMID: 24144524 DOI: 10.1016/j.jfo.2013.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 01/14/2013] [Accepted: 01/15/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To report the financial impact of using modern lens and vitreoretinal surgical techniques. MATERIALS AND METHOD Bottom-up sterilization and consumables costs for new surgical techniques (microincisional coaxial phacoemulsification and transconjunctival sutureless vitrectomy) and the corresponding former techniques (phacoemulsification with 3.2-mm incision and 20G vitrectomy) were determined. These costs were compared to each other and to the target costs of the Diagnosis Related Groups for public hospitals (Groupes Homogènes de Séjours [GHS]) concerned, extracted from the analytic accounting data of the French National Cost Study (Étude Nationale des Coûts [ENC]) for 2009 (target=sum of sterilization costs posted under medical logistics, consumables, implantable medical devices, and special pharmaceuticals posted as direct expenses). RESULTS For outpatient lens surgery with or without vitrectomy (GHS code: 02C05J): the ENC's target cost for 2009 was 339€ out of a total of 1432€. The cost detailed in this study was 4 % higher than the target cost when the procedure was performed using the former technique (3.2mm sutured incision) and 12 % lower when the procedure was performed using the new technique (1.8mm sutureless) after removing now unnecessary consumables and optimization of the technique. For level I retinal detachment surgeries (GHS code: 02C021): the ENC's 2009 target cost was 641€ out of a total of 3091€. The cost specified in this study was 1 % lower than the target cost when the procedure was done using the former technique (20-G vitrectomy) and 16 % less when the procedure was performed using the new technique (transconjunctival vitrectomy) after removal of now unnecessary consumables and optimization of the technique. DISCUSSION AND CONCLUSIONS Contrary to generally accepted ideas, implementing modern techniques in ocular surgery can result in direct cost and sterilization savings when the operator takes advantage of the possibilities these techniques offer in terms of simplification of the procedures to do away with consumables that are no longer necessary.
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Affiliation(s)
- P-L Cornut
- Service d'ophtalmologie, université Lyon-1, hôpital E.-Herriot, hospices civils de Lyon, CHU de Lyon, 5, place d'Arsonval, 69437 Lyon cedex 03, France.
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23- and 20-gauge vitrectomy with air tamponade with combined phacoemulsification for idiopathic macular hole: a single-surgeon study. Am J Ophthalmol 2011; 152:114-121.e1. [PMID: 21529764 DOI: 10.1016/j.ajo.2011.01.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Revised: 01/06/2011] [Accepted: 01/08/2011] [Indexed: 01/31/2023]
Abstract
PURPOSE To compare the results of 23- and 20-gauge vitrectomies combined with phacoemulsification and aspiration and intraocular lens implantation (phacoemulsification surgery) 1 year after repair of idiopathic macular holes. DESIGN Retrospective, consecutive, comparative case series. METHODS The medical charts of 100 consecutive eyes were reviewed that had undergone either 23- or 20-gauge vitrectomy combined with phacoemulsification surgery to treat an idiopathic macular hole performed by 1 surgeon. The rate of improvement of the logarithm of the minimal angle of resolution visual acuity (VA) was calculated using the formula: (postoperative value - preoperative value) × 100/(1-year postoperative value - preoperative value). RESULTS The macular holes closed successfully after the primary vitrectomy in all eyes in both groups. Although the VAs did not differ significantly before surgery or 1 year after surgery between the 2 groups, the VA improvement was significantly greater 1 and 3 months after surgery (P = .02, for both) in the 23-gauge group compared with the 20-gauge group. The induced corneal astigmatism levels 1 week and 1 and 3 months after surgery were significantly lower (P = .01, P = .01, and P = .03, respectively) and the surgical time was significantly shorter (P = .01) in the 23-gauge group than in the 20-gauge group. No apparent complications developed in either group. CONCLUSIONS Since 23-gauge vitrectomy combined with phacoemulsification surgery is advantageous because the VA improved rapidly after treating the macular holes with an acceptable safety profile, idiopathic macular holes are a good indication for 23-gauge vitrectomy combined with phacoemulsification surgery.
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Muselier A, Dugas B, Burelle X, Passemard M, Hubert I, Mathieu B, Berrod JP, Bron AM, Creuzot-Garcher C. Macular hole surgery and cataract extraction: combined vs consecutive surgery. Am J Ophthalmol 2010; 150:387-91. [PMID: 20615492 DOI: 10.1016/j.ajo.2010.04.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 04/11/2010] [Accepted: 04/12/2010] [Indexed: 01/30/2023]
Abstract
PURPOSE To compare the functional and the anatomic outcomes of a combined surgery and consecutive surgery for macular hole and cataract extraction. DESIGN Multicenter, retrospective, comparative case series. PATIENTS One hundred twenty patients (120 eyes) with an idiopathic macular hole and cataract were operated on in 1 or 2 sessions in 2 academic centers, Dijon University Hospital and Nancy University Hospital. Combined surgery (n = 64) and consecutive surgery (n = 56) were performed between 2006 and 2007. All patients underwent pars plana vitrectomy with internal limiting membrane peeling and gas tamponade. Cataract extraction was performed with phacoemulsification followed by a posterior chamber intraocular lens implantation. The main outcome measures were near and far visual acuity at 6 and 12 months, and the rate of closure of macular hole evaluated with optical coherence tomography. RESULTS After a 12-month follow-up, the postoperative best-corrected visual acuities significantly improved in both the combined and the consecutive surgery groups (near and far vision in both groups, P < .0001). However the improvement of far visual acuity was not significant in the consecutive surgery group at 6 months (P = .06) while such an improvement was observed in the combined surgery group (P < .0001). The rates of closure, 100% and 96% in the combined and the consecutive groups respectively, and the complications did not differ significantly between groups. CONCLUSION Both combined and consecutive surgeries are safe and effective methods to treat macular hole and cataract with equivalent functional and anatomic results in both procedures. However, combined surgery shortened the delay for visual recovery.
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Current World Literature. Curr Opin Ophthalmol 2010; 21:239-46. [DOI: 10.1097/icu.0b013e32833983a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Souchier M, Muselier A, Vourch M, Aubé H, Juniot A, Creuzot-Garcher C, Bron AM. T2A et chirurgie orbitopalpébrale : l’ambulatoire est-il vraiment rentable pour l’établissement ? J Fr Ophtalmol 2010; 33:312-8. [DOI: 10.1016/j.jfo.2010.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Accepted: 02/16/2010] [Indexed: 11/27/2022]
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Muselier A, Mathieu B, Aube H, Creuzot-Garcher C, Bron A. [Impact of the Activity-Based Financing (11th Version) on glaucoma surgery payment in hospital resources]. J Fr Ophtalmol 2009; 32:701-6. [PMID: 19939501 DOI: 10.1016/j.jfo.2009.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Accepted: 10/15/2009] [Indexed: 11/25/2022]
Abstract
AIM In this study, the potential impact of 11(th) version of the National Health System's Activity-Based Financing on the income of a University Hospital department was evaluated for glaucoma surgeries. PATIENTS AND METHODS The number of glaucoma surgeries in 2008 was analyzed based on the Medicalization Program of Information Systems. Using the 11(th) version of the Activity-Based Financing for Diagnosis-Related Groups (DRG), we compared the income of these surgical procedures on both an inpatient and an outpatient setting. RESULTS One hundred and forty-nine patients undergoing glaucoma surgery between January and December 2008 were included, 94% of whom were treated on an outpatient basis. The lower reimbursement for outpatient surgery resulted in a loss of euro 100,000 or 64% of revenues compared to an inpatient procedure. DISCUSSION Ambulatory glaucoma surgery is feasible but requires rigorous organization. Nonetheless, while department incomes are related to activity, ambulatory care seems financially disadvantageous. Many departments are trying to develop an ambulatory structure, but the apparent contradiction between the objectives of public health insurance and the hospital's need to balance its budget requires further clarification.
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Affiliation(s)
- A Muselier
- Service d'Ophtalmologie, Centre Hospitalier Universitaire, 3 rue Faubourg Raines, Dijon, France
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