American journal of ophthalmology | 2021
Time to Unplanned Return to the Operating Room and Associated Risk Factors in Patients with Surgical Retinal Detachment Repair.
Abstract
PURPOSE\nTo assess the incidence of unplanned return to the operating room (ROR) at ≤45 days or ≥46 days after primary retinal detachment (RD) surgery and correlate ROR with preoperative risk factors and visual outcomes.\n\n\nDESIGN\nRetrospective Cohort Study METHODS: : A retrospective review of patients with primary retinal detachment surgery to assess for unplanned ROR between January 1, 2012 and June 30, 2014, with follow-up of 90 days to 8 years (mean of 1.5 years).\n\n\nSETTING\nAn academic tertiary referral center.\n\n\nSTUDY POPULATION\n268 patients receiving 270 primary rhegmatogenous retinal detachment surgeries between January 1, 2012 and June 30, 2014.\n\n\nRESULTS\nOf the 270 retinal detachment surgeries, 82 were complicated (history of proliferative vitreoretinopathy (PVR) or trauma-related RDs at presentation), and 188 were uncomplicated (RD unrelated to trauma or PVR at presentation). The ROR rate for all surgeries was 12.2% (33/270) over the follow-up period, with 51.5% (17/33) having reoperations within 45 days. The complicated detachment group had a ROR rate of 14.6% (12/82) over the follow-up period, and 50% of those (6/12) had reoperations within 45 days. The uncomplicated detachment group had a ROR rate of 11.2% (21/188) over the follow-up period. Of those, 52.4% (11/21) had reoperations within 45 days.\n\n\nCONCLUSIONS\nGiven that only 51.5% of all RORs occurred within 45 days, a 45-day ROR surgical quality metric that has been previously utilized may be of limited value for retinal detachment surgery. Factors such as age at presentation, number of retinal breaks, number of detached clock hours, use of silicone oil tamponade for pars plana vitrectomy (PPV), history of choroidal detachment, high myopia, ocular trauma, and open globe were associated with increasing risk of ROR. Implementing risk-adjusted metrics may provide a more accurate and useful quality improvement metric for evaluating quality of surgical care in vitreoretinal surgery.