Open lacrimal surgery: a comparison of admission outcome and complications after planned day case or inpatient management

Abstract

Aims-To assess the outcome, in terms of completion of admission and complication rates, for two series of patients undergoing open lacrimal surgery, one group planned for a day case admission and the other planned for inpatient stay. Methods-A retrospective analysis of case notes was performed for 200 patients planned to have day case admission (for 209 open lacrimal operations) and the details compared with those for 200 inpatient admissions (for 228 lacrimal procedures) during the same period of study. The success rates for surgery were not examined. Results-9% of planned day cases required overnight admission, 5.5% for medical reasons and 3.5% for social or administrative reasons. There was a similar incidence of postoperative complications in planned day cases and inpatients, although 6% of day case patients developed postoperative cellulitis, compared with 1.3% of the inpatients (p= 0.01). Overall, the incidence of cellulitis was greater in cases complicated by intraoperative haemorrhage (p < 0.05) or the use of absorbable nasal packing (p < 0.0001). A similar number of patients in each group attended the accident and emergency department before the planned first postoperative clinic visit. Conclusion-Patients undergoing openlacrimal surgery can be safely managed as day cases if carefully selected for suitability on social and medical criteria. The use of general anaesthesia is not, in itself, a contraindication to day case lacrimal surgery. (Br J Ophthalmol 1998;82:392-396) Following recommendations by the Audit Commission, 1 increasing numbers of cataract and squint operations are performed as day case or ambulatory procedures. In contrast, few surgeons perform external dacryocystorhinostomy (DCR) as a day case procedure and, in any such published series, the surgery is usually performed under local anaesthesia or assisted local anaesthesia. In this paper we present a retrospective analysis of our experience with day case open lacrimal surgery performed, in most cases, with general anaesthesia. The success rate for the surgery is not examined, as this paper is specifically intended to address the outcome in terms of completion of admission episodes and the rate of postoperative complications. Patients and methodsPatients undergoing open lacrimal surgery over a 25 month period to January 1995 were identified using the operating theatre records and the hospital computer administration system. Two hundred consecutive day case admissions and 200 inpatient admissions were selected for comparison. The inpatient group was chosen by selecting, for each day case operation, the next inpatient procedure on the same operating list or, if no inpatient DCR was available or the case had already been selected, the next unselected inpatient DCR was chosen. At Moorfields Eye Hospital, there are several lacrimal theatre lists each week, each being allocated to a particular grade of surgeon, and the method for choosing inpatient "controls" was such that, where possible, each day case and "control" was treated by t...

Simultaneous bilateral external dacryocystorhinostomy

“…Nausea and epistaxis were the most frequent complications that prompted patients to present to the hospital, and various studies have reported the incidence of such complications as 0.5–4.0% (Dresner et al. 1991; Hanna et al. 1998; Tsirbas & McNab 2002).…”

“…Dacryocystorhinostomy on an outpatient basis is generally accepted as a safe procedure. Nausea and epistaxis were the most frequent complications that prompted patients to present to the hospital, and various studies have reported the incidence of such complications as 0.5-4.0% (Dresner et al 1991;Hanna et al 1998;Tsirbas & McNab 2002). A study conducted on 112 patients between the ages of 70 and 90 reported no serious complications following external DCR (Hurwitz et al 2000).…”

“…Acquired NLDO affects both lacrimal drainage systems in many patients. In large series, the percentage of patients who have undergone bilateral DCR ranges between 9 and 18% (Hurwitz & Rutherfors 1986;Tarbet & Custer 1995;Hanna et al 1998;Vardy & Rose 2000;McNab & Simmie 2002;Dolman 2003). In patients with bilateral NLDO, performing DCR on both sides at the same session may be more practical and cost-effective than separate operations (Hurwitz & Mishkin 1989).…”

Long-Term Results of Simultaneous Bilateral External Dacryocystorhinostomy in Cases with Bilateral Dacryostenosis

“…Different studies show that the percentage of patients who have undergone bilateral DCR varies between 9% and 18%. [3][4][5][6][7][8] *This study was presented at the 28th Annual Meeting of European Society of Ophthalmic and Plastic Surgery, Munich, Germany, September 9-11, 2010. Correspondence: Dilek Yuksel, Ministry of Health, Ankara Training and Research Hospital, Department of Ophthalmology, Ankara, Turkey.…”

Management of acquired nasolacrimal duct obstruction: external and endonasal dacryocystorhinostomy. Is there a third way?

“…The procedure has remained largely unchanged since, with improvement in success rates largely due to advances in suture materials, anaesthesia and instruments. The external DCR, the procedure by which all other techniques are judged, gives a success rate of between 90 and 95%4 5 6 7 although the occasional modern study still shows success rates around 75% 8…”