Return to OR After RD Repair: Revisiting the 45-Day Metric
By Lynda Seminara
Selected By: Richard K. Parrish II, MD
Journal Highlights
American Journal of Ophthalmology, September 2021
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Researchers are assessing unplanned returns to the OR as a quality measure of surgical care, especially returns within 45 days. To evaluate the appropriateness of the 45-day metric for surgical repair of retinal detachment (RD), Grosinger et al. reviewed medical records of patients who underwent the procedure. They found that risk-adjusted metrics and a longer post-op period may be warranted to adequately measure the caliber of surgical care.
The study included 268 patients (mean age, 58.6 years) and 270 primary repairs. Eighty-two detachments were considered complicated (trauma-related RD or proliferative vitreoretinopathy [PVR] history at presentation), and 188 were deemed uncomplicated. The minimum follow-up time was 90 days (mean, 1.5 years).
Altogether, 33 (12.2%) of the 270 primary procedures resulted in unplanned return to the OR during the follow-up period, and 17 (51.5%) of these reoperations occurred within 45 days. Among the complicated RD group, return to the OR was required in 12 (14.6%) of 82 cases, six of which (50%) occurred within 45 days. In the uncomplicated group, return to the OR was needed for 21 (11.2%) of 188 cases, 11 of which (52.4%) took place within 45 days. The mean time to return was 70.9 days overall, 75 days for complicated cases, and 68.6 days for uncomplicated cases.
Among the entire study population, factors significantly associated with greater risk of unplanned return to the OR were high myopia, pars plana vitrectomy requiring silicone oil tamponade, trauma-related detachment, and history of choroidal detachment or open globe. Overall, unplanned returns to the OR correlated with poorer visual outcomes, regardless of the time to re-operation. As only about half of the cases of return to the OR occurred within 45 days, the authors believe that longer follow-up may be warranted to properly evaluate the quality of RD surgery.
The original article can be found here.