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Alexander Grosinger, Benjamin Nicholson, Jose Pulido, Andrew Barkmeier, Raymond Iezzi, Sophie J Bakri; Quality metrics and retinal detachment surgery: Time to unplanned return to the operating room. Invest. Ophthalmol. Vis. Sci. 2016;57(12):No Pagination Specified.
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© ARVO (1962-2015); The Authors (2016-present)
To assess 45-day return to the operating room (ROR) as a quality metric in retinal detachment surgery.
Eyes with a new clinical diagnosis of untreated rhegmatogenous retinal detachment between January 2012 and June 2014 were identified by querying the institutional electronic medical record. Charts were reviewed to identify all subjects who returned to the operating room. Forty-five day ROR was the primary outcome variable, and data was also collected on any ROR that occurred outside this 45-day period. Data regarding numerous clinical characteristics were analyzed for associations with ROR. For all ROR events, the charts were reviewed subjectively to identify possible causes for ROR.
Three hundred seven previously untreated retinal detachments were identified, and 220 were uncomplicated detachments (PVR detachments and trauma-related detachments were excluded). The uncomplicated detachment group had a 45-day ROR of 12/220 (5.5%). The ROR rate over the entire follow-up period was 23/220 (10.5%). The mean final visual acuity in 45 day ROR eyes was 1.19±1.13 (~20/310) versus 0.34±0.38 (~20/43) in those with no ROR (P=0.026). The mean time to ROR in the uncomplicated group was 71.8 days (range 5-312 days). The “all detachment” group had a 45-day ROR rate of 21/307 (6.8%). The ROR rate over the entire follow-up period was 41/307 (13.3%). The multivariate analysis to assess for risk factors for 45 day return showed the following associations: a history of an open globe injury (P=0.0050) and more clock hours of detachment (P=0.043). Among these 45 day RORs, 11/21 (52%) were associated with pre-existing extenuating circumstances.
The 45-day ROR metric captured about half of all ROR events. Even after exclusion of trauma and PVR-related detachments, one third of all 45 day RORs were related to pre-existing extenuating circumstances including acute retinal necrosis and macular hole. ROR was associated with significantly worse visual outcomes, both in the 45 day ROR groups and the all-time ROR groups.
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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