Elsevier

Ophthalmology

Volume 99, Issue 9, September 1992, Pages 1358-1363
Ophthalmology

Outcome and Cost Analysis of Scheduled versus Emergency Scleral Buckling Surgery

https://doi.org/10.1016/S0161-6420(92)31794-4Get rights and content

Background: Retinal detachments are usually considered to be a surgical emergency. However, there are additional risks and costs for unnecessary emergency surgeries. The purpose of this study is to evaluate whether the conventional wisdom for treating all retinal detachments as emergencies needs to be re-examined.

Methods: Forty-eight patients who had an emergency scleral buckle and 89 patients who had a scheduled procedure were randomly selected from 884 consecutive patients who had a primary scleral buckling procedure during a 4 1/2-year period. The medical records of each patient were used to obtain detailed information related to prognosis. The visual acuity measurements of each patient, taken 6 months after the procedure, were obtained from the records of the ophthalmologist following the patient. Linear regression analysis was used to compare the final visual outcome for patients who had emergency surgery with patients who had scheduled surgery after taking into account patient factors related to prognosis.

Results: Patients selected for emergency surgery had better visual prognoses than scheduled patients but had the same risk of systemic complications and the same extent of detachment if the macula was not involved. None of the 18 patients with an attached macula experienced macular involvement while awaiting scheduled surgery. There were no differences between emergency and scheduled patients in ocular or systemic complications, rate of reattachment, rate of decreased visual acuity after surgery, visual outcome adjusted for prognosis, or, since 1985, length of hospital stay. A greater cost was incurred for the patients having emergency surgery due to difference in pay scales for support personnel.

Conclusions: Because the study is not large and the patients were not randomized to treatment, the results are not definitive. However, they suggest that emergency surgery is unnecessary for many patients with a detached retina.

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    2010, American Journal of Ophthalmology
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    The physician has opportunity to approach the surgery without disrupting scheduled clinics and with a familiar staff. The health system may be afforded a better opportunity to deliver the care in a more cost-effective and less disruptive manner.18 It would seem reasonable that these findings could be extrapolated beyond RRD eyes undergoing scleral buckling to include all RRD treatment modalities.

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    2007, Ophthalmology
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    The mean best-corrected postoperative VA of patients operated on the first day of macular detachment was the lowest of all patients in the immediate group. In Hartz et al’s study,15 the most important reason for performing immediate emergency surgery was the inability to schedule an operating room the next day, but patient characteristics also influenced how surgery was scheduled.10 In our series, the 2 patients operated on the first day of macular detachment had low preoperative VA, which can be one of the explanations for their worse visual outcome.

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Presented at the 127th Annual Meeting of the American Ophthalmological Society, Pebble Beach, May 1991.

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