• 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.