Is day-case cataract surgery an attractive alternative from the patients' point of view? A questionnaire survey

Abstract

Cataract surgery is the most common elective surgical procedure undertaken in elderly people. In many European countries and in the USA cataract surgery is normally a day-case procedure without an overnight stay in hospital, unlike the situation in Austria where fewer than 2% of patients are day cases. However, there is a lack of prospective studies on patients' need for and acceptance of day-case surgery. The aim of our study was therefore to evaluate patients' demand and suitability for outpatient surgery, based on analysis of preoperative questionnaires on availability of family and/or social support and on preoperative ophthalmologic examination. Among 500 consecutive patients with cataract, 154 (41.8%) chose a day-case procedure and 256 (58.2%) preferred inpatient admission. Patients preferring full admission were older (mean age 76.4+/-8.1 vs. 72.73+/-9.5 years, P<0.001), had worse visual acuity (0.55+/-0.20 vs. 0.66+/-0.23, P<0.001), were more likely to be female (63.9% vs. 47.0%, P=0.001), to live more than one hour away from the hospital (26.5% vs. 12.5%, P<0.001) and have no carer at home (43.0% vs. 6.5%, P<0.001). Patients favoring day-case surgery were more likely to be able to attend an ophthalmologic check-up 24 h after surgery (96.7% vs. 59.6%, p<0.001). The majority of patients indicated a preference for inpatient care, but this may be a reflection of their previous hospital experience and a matter of custom in the elderly population. Information, education and better organization of after-surgery services could help increase the attractiveness of cataract surgery as an outpatient procedure in Austria. Our findings could also be relevant to day-case services in medical care in general.

An instrument assessing patient satisfaction with day care in hospitals

“…Part of the day care patients will have surgery in the operation room and/or have an intake visit with a nurse. The importance of the pre-admission visit for day care is supported by the literature: it is associated with reduced anxiety and increased satisfaction [5,6,29-31]. The questionnaire was tested in a large sample of patients from five general hospitals in the Netherlands.…”

Day case hernia repair: weak evidence or practice gap?

“…For patients living outside metropolitan areas, the extended travelling distance between hospitals and patients' residence may become an obstacle to day surgery. 13,35,36 Therefore, community support systems, including rapid recovery centres or transportation services, are required for day surgery hospitals located in regional and rural areas.…”

The switch between cataract surgical settings: Evidence from a time series analysis across 20 EU countries

“…In Austria the number of day-care units is still low and the distribution of ophthalmologists is very uneven. Most of them are concentrated in the cities, and very few services and contracts for specialists are offered in countryside areas; consequently, a long distance to hospitals and underdeveloped patient support, such as transportation services and hotels adjacent to the hospitals, influence the ratio of same-day cases [ 10 ]. Also, as reported by Kroneman [ 21 ], oversupply of inpatient beds still leads to a preference for inpatient care.…”

“…Previous studies have inspected the issue of same-day cataract surgery rates. However, these studies focused on rates of a single country [ 9 , 10 ] or analyzed differences in the rates of many countries or regions and determined the factors influencing them for a single year [ 11 , 12 ].…”