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Chase Miller, Llewelyn Rao, Joan Hornik, Douglas Rowland; Retinal Surgery Case Selection and Safety in an Ambulatory Surgery Center versus Hospital. Invest. Ophthalmol. Vis. Sci. 2016;57(12):5579.
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© ARVO (1962-2015); The Authors (2016-present)
There has been a migration of retinal surgical cases over the past decade to ambulatory surgery centers (ASCs) from hospital outpatient surgery departments (HOPDs) due to increased efficiency. We evaluated retinal surgery case selection and safety in an ASC versus an HOPD.
We retrospectively analyzed retinal surgical case selection and safety in a large single retinal specialty practice over a 5-year period (7-1-10 to 6-30-15). The total number of cases done at an ASC and an HOPD were reviewed and categorized by common procedural terminology (CPT), and the 10 most common CPT codes were analyzed. Categorical data were summarized by counts and percents. Relative frequencies of procedures were compared by the chi-square test of contingency table data or Fisher’s exact test. We assessed safety through review of medical incident reports and hospital admissions related to the procedures. Rates of incidents were calculated along with 95% confidence intervals (95% CIs) by the modified Wald method. Proportions of incidents were compared by Fisher’s exact test for all procedures, combined, as well for subgroupings, elective and emergent. We also reviewed the reasons that cases were scheduled at the HOPD over the ASC for the most recent 18 months (1-1-14 to 6-30-15).
Total ASC cases numbered 5737 vs HOPD 213. There was a significant (p < .001) difference in the relative frequencies of procedures at ASC vs HOPD for all 10 of the most common retinal surgery CPT codes. For safety, the rate of medical incidents was 7 in 5,737 procedures (0.12%) (95% CI: 0.05% to 0.26%) at ASCs and 0 in 213 procedures (0%) (95% CI: 0.00% - 2.13%) at HOPD. For all procedures aggregated, as well as for each subgrouping, elective and emergent, 95% CIs of ASCs and hospitals overlapped. Examining these data with Fisher’s exact test, there were no statistically significant differences in medical incidents, either for all procedures combined (p = .21) or for the subgroupings, elective and emergent (p > .99 for each subgrouping). There were 43 cases performed at the HOPD over the last 18 months: 30 scheduling conflicts, 6 insurance requirements, 5 pediatric cases, and 2 medical indications.
There was significantly more utilization of the ASC over the HOPD for all categories of retinal surgery cases, elective and emergent, with no apparent medical safety concerns.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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