Abstract
Purpose :
Ophthalmology surgery cancellation causes a disruption in care, worsening patient outcomes and reducing hospital performance and patient satisfaction. This study evaluates surgical case cancellation (CC) rates for all ophthalmic subspecialities, barriers to surgery utilization (Figure 1), and areas for interventions within the Veterans Health Administration (VA) system.
Methods :
We completed a retrospective review of all surgical case requests from the VA in 2019. Patients with cataract, retina, glaucoma, and oculoplastic (OP) surgery cancellations were evaluated on gender, race, residence, previous eye surgery, if legally blind in the operative or nonoperative eye, and medical history (ie. hypertension, diabetes). Cross tabulation followed by chi-squared tests helped determine the significance of each variable as it pertained to surgery cancellation.
Results :
A total of 1139 ophthalmic surgical requests were identified with an overall case cancellation (CC) rate of 23.7% (n=270). CC rates by specialty included: OP at 37.7% (N=43), cataract at 23.1% (N=179), retina at 20.9% (N=18), and glaucoma at 11.8% (N=11). Compared to cataract surgery, OP surgery was more likely to have CC (OR 2.0, p<.001) while glaucoma was less likely (OR 0.45, p=.015). Cataract surgery with minimally invasive glaucoma surgery was less likely to have CC than cataract surgery alone (OR 0.20, p=.002). In retina, those with macular holes were more likely to cancel than those with retinal detachment (OR 12.4, p=.004). Data including gender, race, and residency type were similar between those who completed surgery and those with CC. However, retina patients with PTSD were more likely to have CC (OR 4.2, p=.014) and glaucoma patients with depression (OR 4.0, p=.044) and anxiety (OR 5.8, p=.050) were more likely to have CC.
Conclusions :
There was a significant amount of ophthalmic CC’s prior to the COVID-19 pandemic with OP cases making up the majority. Demographic factors including race and ethnicity did not impact CC, while medical history, specifically psychiatric history did. Possible areas to reduce CC rates include pre-operative assessments to identify patient vulnerabilities and patient education prior to placing surgical requests. Further investigation is needed to determine interventions that reduce CC caused by both patient and facility factors.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.