Abstract
Purpose :
Faced with growing demand for eye care, healthcare payors are pressuring providers to reduce costs in cataract surgery. Scrutiny has extended to the role of anesthesia in routine cases. With the necessity of monitored anesthesia care now in question, we assess post anesthesia complications after cataract surgery at a major academic center.
Methods :
A retrospective study of primary cataract surgery without modifiers from 2013-2021 at our institution was conducted. Complications were defined as prolonged post anesthesia recovery (more than 2 hours) and admission or emergency room visits within 48 hours after surgery. Complication cause and post operative intravenous medications were recorded.
Results :
Of 16,240 cataract surgeries, 2% (312/16240) of cases required a prolonged post-operative recovery time. The average post-operative recovery time was 54 minutes (SD 26) for cases under monitored anesthesia care. 1% of cases were performed under general anesthesia with an average recovery time of 94 minutes (SD 59). Non-exclusionary causes of delayed recovery included post-operative nausea and vomiting (25%), pain control (15%), hypotension (6%), bradycardia (4%), hypoxia or respiratory issues (4%), and arrythmias (2%). 3% of patients with prolonged recovery required vasopressors. Of all cataract cases, 5% were given IV medications in recovery. In comparison, 39% of cases with prolonged stays received IV medications. For extended stay patients, 11% of IV medications given were for blood pressure or arrythmia control.
0.2% of all cataract cases had an unplanned institutional admission, surgery, or ED visit within 48 hours. Of these visits, the most common causes were post-operative eye complications (55%) and cardiac complications such as arrythmia or syncope (14%). Limitations of this study include possible higher case complexity and comorbidities of patients treated at an academic tertiary center.
Conclusions :
At an academic institution, non-ophthalmologic admissions and emergency visits after cataract surgery are rare. However, recovery complications can require substantial post-operative management and delay discharge. While pain and nausea control are most common, some patients require urgent blood pressure or cardiac management. The role of monitored anesthesia care remains important to managing recovery complications that can be challenging for surgeons to address from the operating room.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.