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    Emergency Visits After Cataract Surgery

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    Why do some patients seek emergency care after their cataract surgery? According to a Duke University study, younger age, longer case times, and retrobulbar or general anesthesia plus monitored anesthesia care (MAC) were significantly associated with visits to the emergency department (ED) within 30 days of cataract surgery.1

    “Recognizing the risk factors for ED visits after cataract surgery can help us manage patients in the early postoperative period to prevent unplanned health care utilization and reduce treatment costs,” said Sahil Aggarwal, MD, at Duke Eye Center in Durham, North Carolina. “Mitigating these risk factors can also reduce complications and improve patient satisfaction after cataract surgery.”

    Study rationale. “Prior to this study, we saw a small number of patients who had ophthalmic surgeries and presented to the ED within a few weeks, but almost none of these patients were admitted,” said Dr. Aggarwal.

    To better understand this phenomenon, the team investigated the risk factors for postoperative ED visits in 34,246 patients who underwent cataract surgery from 2013 to 2021. “We hypothesized that most ED visits would result from nonocular causes and that the complexity of surgery might predict the risk of postop­erative ED visitation,” Dr. Aggarwal said.

    Who’s at risk? Only 607 (1.77%) of the cataract patients visited the ED within 30 days of surgery. Most of these visits were due to cardiovascular complaints (24.4%). Only 15.4% of ED visits were associated with ocular issues, most commonly high IOP, rebound iritis, and posterior vitreous detachment.

    Younger patients (<70 years of age) were more likely than older patients to seek emergency care (OR, 1.39). This may be because younger patients are less likely to have a primary care provider and thus are more likely to turn to the ED when they need care, Dr. Aggarwal noted. Longer case length (>30 minutes) also increased the odds of ED visits (OR, 2.1), as did the combination of MAC and retrobulbar or general anes­thesia (OR, 2.98). Case length provides an indication of complexity, and “longer cases may lead to greater inflammation, IOP variability, and anesthesia-related complications,” Dr. Aggarwal said.

    Looking ahead. “Prospective studies of the preop­erative history of patients are needed to validate risk factors for postoperative ED visits,” Dr. Aggarwal said. He added that the Duke team plans to examine risk factors for ED visits after glaucoma, cornea, and retina surgeries.

    —Christos Evangelou, PhD

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    1 Aggarwal S et al. Am J Ophthalmol. 2023;245:1-7.

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    Relevant financial disclosures: Dr. Aggarwal—None.

    For full disclosures and the disclosure key, see below.

    Full Financial Disclosures

    Dr. Aggarwal None.

    Dr. Al-Aswad AI Optics: C; Alcon: C; Bausch + Lomb: C; EnVision Health Technologies: EE; GlobeChek: PS; Mother Cabrini Health Foundation: S; New World Medical: S; Research to Prevent Blindness: S; Russell Berrie Foundation: S; Save Vision Foun­dation: C,S; Topcon: C,S; Virtual Field: C; Visi Health Technol­ogies: EE; World Care Clinical: C.

    Dr. Do Allergan/AbbVie: C,L; Alimera Life Sciences: C,L; Apellis: L; Bausch + Lomb: C,L; EyePoint: C,L.

    Dr. Winn Columbia University: P.

    Disclosure Category

    Code

    Description
    Consultant/Advisor C Consultant fee, paid advisory boards, or fees for attending a meeting.
    Employee E Hired to work for compensation or received a W2 from a company.
    Employee, executive role EE Hired to work in an executive role for compensation or received a W2 from a company.
    Owner of company EO Ownership or controlling interest in a company, other than stock.
    Independent contractor I Contracted work, including contracted research.
    Lecture fees/Speakers bureau L Lecture fees or honoraria, travel fees or reimbursements when speaking at the invitation of a commercial company.
    Patents/Royalty P Beneficiary of patents and/or royalties for intellectual property.
    Equity/Stock/Stock options holder, private corporation PS Equity ownership, stock and/or stock options in privately owned firms, excluding mutual funds.
    Grant support S Grant support or other financial support from all sources, including research support from government agencies (e.g., NIH), foundations, device manufacturers, and\or pharmaceutical companies. Research funding should be disclosed by the principal or named investigator even if your institution receives the grant and manages the funds.
    Stock options, public or private corporation SO Stock options in a public or private company.
    Equity/Stock holder, public corporation US Equity ownership or stock in publicly traded firms, excluding mutual funds (listed on the stock exchange).

     

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