Hospitalization Requirements After Vitreoretinal Surgery

Isernhagen, Rick; Michels, Ronald G.; Glaser, Bert M.; Bustros, Serge de; Enger, Cheryl

doi:10.1001/archopht.1988.01060130837035

Cited by 32 publications

(21 citation statements)

References 4 publications

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“…Previous published results supported in-patient care because of significant ocular and systemic morbidity following VR procedures. [5][6][7][8][13][14][15][16][17] In 1988, Isernhagen et al prospectively analysed 200 patients and concluded that in patient care was better suited for 52% of their patients with 40% requiring intramuscular injections for relief of pain or nausea and 15% requiring physician attention for systemic illness more than 5 h following surgery. In their survey, 79% patients indicated that they would be uncomfortable with ambulatory surgery.…”

Section: Discussionmentioning

confidence: 45%

“…In their survey, 79% patients indicated that they would be uncomfortable with ambulatory surgery. 6 Ninety per cent of the patients had local anaesthesia with sedation. However, more recent published data show strong evidence of the effectiveness of local anaesthesia in intraoperative comfort and in controlling postoperative pain.…”

Section: Discussionmentioning

confidence: 47%

“…This was mainly due to ocular and systemic morbidity associated with VR procedures: ocular pain, raised intraocular pressure (IOP), and diabetes-related medical complications being the most important. [5][6][7][8] There has been a significant shift towards local anaesthesia for VR surgery, but there are no recent published data for day-case surgery. Previously, cataract surgery involved similar routine overnight stay.…”

Section: Introductionmentioning

confidence: 42%

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Feasibility of day-case vitreoretinal surgery

Desai

Rubinstein

Reginald

et al. 2006

Eye

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Purpose The indications for vitreoretinal (VR) surgery are increasing as equipment and techniques available improve. In order to decrease demand on limited health resources, day-case surgery would be beneficial in many cases. This study combines a retrospective and prospective arm to examine the feasibility and safety of routine day-case VR surgery. Methods One hundred consecutive patients (50 retrospective and 50 prospective) undergoing VR surgery within the Royal Berkshire NHS trust were included. The retrospective arm aimed to identify the frequency and type of acute ophthalmic or medical intervention during postop overnight stay and the results were used to alter management in the prospective group. The prospective group consisted of patients undergoing a mixture of overnight stay and day-case surgery. All patients in the prospective group had routine subtenon marcaine anaesthesia together with prophylactic pre-operative intravenous acetazolamide. Patients deemed fit postoperatively were offered overnight ward discharge, with obligatory next-day review. Results In the retrospective arm, 56% required oral nonsteroidal analgesia on the day of surgery and one patient required narcotic analgesia. Twenty-two per cent patients required intraocular pressure (IOP) control on the day of surgery and one patient required medical intervention in the form of urinary catheterisation. Nineteen patients required intervention on next-day review. In the prospective arm, 86% preferred day case and were suitable, 6% were suitable for day-case but preferred overnight stay and 8% were deemed not fit for discharge. No patient required narcotic analgesics. No patient discharged returned as a casualty overnight. Only one patient required topical beta-blocker for the control of IOP on next-day review.Conclusions These data suggest that many patients who are hospitalised overnight for VR surgery could be safely treated as day cases. Such a shift in the pattern of care for VR surgery could provide a significant improvement in health-care efficiency and minimise patient inconvenience.

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Section: Discussionmentioning

confidence: 45%

Section: Discussionmentioning

confidence: 47%

Section: Introductionmentioning

confidence: 42%

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Feasibility of day-case vitreoretinal surgery

Desai

Rubinstein

Reginald

et al. 2006

Eye

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“…Host of factors influence the specifics of PPV surgery resulting in varying preferences of anaesthesia and surgery. The choice of anaesthesia may be dictated by factors such as surgeon's preference, patient's age and preference as well as complexity of surgery, anticipated difficulty and duration of surgery [2][3]. Surgeon's preferences may be influenced by personal experience, availability of anaesthesia provider, influence of mentors, advances in technology, disease understanding, prevailing preferences of close colleagues, differential reimbursement incentives, instrument costs, personal attitude toward trying new approaches and bias [4].…”

Section: Introductionsupporting

confidence: 41%

Effectiveness of single injection sub-Tenon’s block for Pars Plana Vitrectomy and associated procedures

Kumar¹,

Seet²,

Macachor³

et al. 2017

New Front Ophthalmol

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“…This finding has dictated the current standard of care, which suggests that best clinical practice must include a postoperative first day review for all patients undergoing vitreoretinal (VR) surgery. However, of the postoperative events cited by Isernhagen et al, 1 the majority were side effects of general anaesthesia rather than ocular surgical complications. With increasing use of local anaesthesia in VR surgery, the use of smallergauge vitrectomy instruments and optimisation of the postoperative treatment regimen, postoperative events following uncomplicated surgery have become uncommon.…”

Section: Introductionmentioning

confidence: 47%

Is day-1 postoperative review necessary after pars plana vitrectomy?

Alexander

Michaels

Newsom

2015

Eye

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Purpose This study aimed to determine the proportion of patients requiring alteration in management based on the findings of the day-1 postoperative visit after pars plana vitrectomy, and to identify clinical characteristics that predict the need for unexpected intervention. Patients and methods A retrospective case note review was conducted of all patients who underwent pars plana vitrectomy and who then attended for review on the first postoperative day. All patients received routine prophylactic anti-glaucoma medication.Results Two hundred and seventy-three patients examined on day 1 following vitrectomy were studied. Indications for surgery included retinal detachment, epiretinal membrane, macular hole, vitreous haemorrhage, diabetic eye disease, and floaters. Twenty-gauge (20G) vitrectomy was performed in 124 eyes (45%); 23-gauge (23G) vitrectomy was performed in 149 eyes (55%). Phacoemulsification was performed concurrently in 51/273 (19%) eyes. Ten patients (3.7%) required unexpected intervention on day 1 owing to intraocular pressure (IOP) 430 (2/273), IOP o6 (5/273), or unexpected return to theatre for anterior chamber washout (3/273). There was no difference in intervention rate or day-1 IOP between 20G and 23G cases. Hypotony was less common if gas tamponade was used (χ 2 -test, Po0.001). Patients undergoing combined phacoemulsification and 20G vitrectomy were significantly more likely to require intervention on day 1 than patients undergoing 20G vitrectomy alone (15.0 vs 1.9%, P = 0.029, Fisher's exact test) but this was not the case for patients undergoing 23G vitrectomy (0 vs 4.2%, Fisher's exact test, P = 0.58). Conclusions The intervention rate on the first day after vitrectomy is low and day-1 postoperative review can be safely omitted in the majority of patients undergoing vitrectomy.

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Hospitalization Requirements After Vitreoretinal Surgery

Cited by 32 publications

References 4 publications

Feasibility of day-case vitreoretinal surgery

Feasibility of day-case vitreoretinal surgery

Effectiveness of single injection sub-Tenon’s block for Pars Plana Vitrectomy and associated procedures

Is day-1 postoperative review necessary after pars plana vitrectomy?

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