Hospitalization after Cataract Surgery in a Nationwide Managed-Care Population

Younger Age and Longer Case Times Associated With Emergency Department Visits After Cataract Surgery

PURPOSE

To characterize the frequency, reasons, hospital costs, and risk factors for emergency department (ED) visits within 30 days of cataract surgery.

DESIGN

Retrospective cohort study.

METHODS

A retrospective review of all cataract surgeries at Duke Health between 2013 and 2021 was conducted. Demographics, case characteristics (length, complexity by billing codes, anesthesia type), ED visit findings, and hospital costs were collected. Logistic regression models were used to determine the odds of ED visits based on several risk factors.

RESULTS

Of 34 246 patients (57 656 eyes) undergoing cataract surgery at Duke Health from 2013 to 2021, a total of 607 patients (1.77%) had 680 ED visits within 30 days of surgery. The most common ED diagnosis was cardiovascular (24.4%), whereas ocular complaints constituted 15.4% of visits. The most common ocular diagnoses were high intraocular pressure, rebound iritis, and posterior vitreous detachment. Hospital costs were lowest for ocular diagnoses (mean $467.72) and highest for trauma diagnoses (mean $4660.55). Risk factors for ED visits included case lengths greater than 30 minutes (OR 2.1, 95% CI 1.56-2.83, P < .001), the combination of Monitored Anesthesia Care (MAC) and retrobulbar anesthesia or general anesthesia (OR 2.98, 95% CI 1.73-5.12, P < .001), and age less than 70 years (OR 1.39, 95% CI 1.16-1.65, P < .001).

CONCLUSIONS

ED visits within 30 days of cataract surgery are uncommon. Longer case lengths, anesthesia other than MAC alone, and younger age are associated with higher odds of ED visits.

Application of evidence-based nursing in patients after cataract surgery and its impacts on visual acuity recovery and psychological status

OBJECTIVE

To probe into the evidence-based nursing in patients after cataract surgery and its impact on their visual acuity recovery and psychological status.

METHODS

Ninety-seven patients with cataract who underwent surgery in our hospital were randomly divided into control group (n=48, receiving conventional nursing) and observation group (n=49, receiving evidence-based nursing) for a prospective study. Postoperative visual acuity recovery, incidence of complications, recurrence rate within 1 year, psychological status before and after surgery and quality of life were compared between the two groups.

RESULTS

The best corrected visual acuity of the affected eye of patients at 3 and 6 months after surgery in both groups was significantly higher than that before surgery, with the best corrected visual acuity of the same period in the observation group higher than that in the control group (all P<0.05). The incidence of postoperative complications and recurrence rate within 1 year in the observation group were lower than those in the control group (all P<0.05). Three months after operation, the scores of Hamilton Anxiety Scale and Hamilton Depression Scale in the two groups were lower than those before operation, with the scores in the observation group lower than those in the control group (all P<0.05); and the scores of all items in Generic Quality of Life Inventory in the two groups were higher than those before operation, with the scores in the observation group higher than those in the control group (all P<0.05).

CONCLUSION

Evidence-based nursing for patients after cataract surgery can significantly improve the recovery of patients' postoperative visual acuity, reduce the incidence of postoperative complications as well as the recurrence rate. It also helps to improve the adverse psychological status of patients and their postoperative quality of life.

Trends in Use of Ambulatory Surgery Centers for Cataract Surgery in the United States, 2001-2014

Importance

Cataract surgery is commonly performed at ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs). These venues differ in many ways, including surgical efficiency, patient throughput, patient safety, and costs per surgery.

Objective

To determine trends in use of ASCs and HOPDs for cataract surgery from 2001 to 2014 and factors affecting the site of surgery.

Design, Setting, and Participants

This retrospective longitudinal cohort analysis involved individuals 40 years and older who underwent cataract surgery between January 2001 and December 2014 from a nationwide US managed care network. Data were analyzed from February 2016 to February 2017.

Main Outcomes and Measures

We identified all enrollees who underwent cataract surgery and determined whether the surgery was performed at an ASC or HOPD. We calculated the proportion of surgeries performed at each site each year from 2001 to 2014. Multivariable logistic regression identified characteristics of enrollees who had cataract surgery at an ASC vs a HOPD. We also assessed geographic variation in the proportion of cataract surgeries performed at ASCs in 306 communities throughout the United States.

Results

Of the 369 320 enrollees included in this study, 208 319 (56.4%) were female, and the mean (SD) age was 66.3 (10.4) years. All enrollees underwent cataract surgery (531 325 surgeries) from 2001 to 2014. Of these, 237 046 (64.2%) underwent cataract surgery at an ASC. The proportion of cataract surgeries performed at ASCs increased from 43.6% in 2001 to 73.0% in 2014. Compared with enrollees with incomes less than $40 000, those with incomes greater than $100 000 were 20% more likely to undergo cataract surgery at an ASC (odds ratio, 1.20; 95% CI, 1.12-1.29). Enrollees with better overall health were no more likely to undergo cataract surgery at an ASC (odds ratio, 1.00; 95% CI, 0.99-1.00) than at an HOPD. Enrollees who lived in communities without certificate of need laws were more than twice as likely to have surgery at an ASC (odds ratio, 2.49; 95% CI, 2.35-2.63). The proportion of cataract surgeries performed at ASCs from 2012 to 2014 varied considerably, from 1.6% in La Crosse, Wisconsin, to 98.8% in Pueblo, Colorado.

Conclusions and Relevance

We observed a large shift in the site of cataract surgery from HOPDs to ASCs from 2001 to 2014. Future research is needed to assess the effect of this transition in site of surgical care on patient access to surgery, surgical outcomes, patient safety, and societal costs.