Reoperation for rhegmatogenous retinal detachment as quality indicator for disease management: a register study

Abstract

ABSTRACT.Purpose: To establish a quality indicator that could be used in optimizing treatment for rhegmatogenous retinal detachment (RRD). Methods: The Danish National Patient Registry was used to identify surgery conducted in Denmark for RRD in the period 01 January 2001-31 December 2009. Cases were identified by diagnosis and surgical codes. Results: A total of 6522 cases were operated for a primary RRD in the study period, and 22% (1434 patients) were reoperated for a redetachment. A Cox regression analysis showed that the risk of redetachment was equal to or less than detachment on the fellow eye 1 year after primary surgery with techniques not using silicone oil. The same was true 1.5 years after surgery for techniques using silicone oil. Based on this, we established a quality indicator defining failure as the need for operation for redetachment within 1 year from initial surgery when using techniques without oil and after 1.5 years for techniques using oil. Also the lack of oil removal within 1 year from initial surgery should be noted as an operational failure.We applied the quality indicators on the cohort of 6522 RRDs and found that in Denmark the need for redetachment surgery has decreased over time and also that high-volume departments have better outcome compared to smaller ones. Conclusions: The risk of reoperation for redetachment after initial surgery fulfils the criteria for a good quality indicator and can be used in RRD surgery. This indicator could aid in optimizing the management of RRD patients to minimize morbidity.

Rhegmatogene Netzhautablösung

“…In den letzten Jahren finden sich nationale Registerstudien aus dem Vereinigten Königreich als auch aus Dänemark, bei denen eine systematische digitale Erfassung der durchgeführten Leistungen, Komplikationen und Folgeoperationen durchgeführt worden ist [26,54,55,56,57,58] [58]. Das größte Risiko der Entstehung einer pseudophaken Netzhautablösung wird in den ersten 6 Monaten nach der Operation beobachtet und flacht danach ab, bleibt aber sogar 10 Jahre nach der Kataraktoperation weiterhin erhöht.…”

Royal College of Ophthalmologists' National Database Study of Vitreoretinal Surgery

“…Significant variation in reported primary RD failure exists. [10][11][12][13][14][15][16][17][18][19] This range may be due to variations in patient selection including surgical complexity, the definition of primary RD failure, the timeframe for reporting failure, and the inclusion or exclusion of cases with silicone oil in situ. A recent nationwide database study from Denmark found a 22% re-operation rate after RD surgery, using a large subset of 6,522 eyes of which 29.5% received silicone oil injection.…”

“…A recent nationwide database study from Denmark found a 22% re-operation rate after RD surgery, using a large subset of 6,522 eyes of which 29.5% received silicone oil injection. 15 Data from a European randomized controlled trail of SB and Primary PPV in RD 10 that had restricted entry criteria and considered any postoperative retinopexy procedure even without the use of tamponade or subsequent macular pucker surgery as a failure, reported a primary mean failure rate of 36.8%. However, a more recent retrospective case-note review study 14 using similar retinal surgery techniques but with less strict criteria for defining primary failure, reported a substantially lower failure rate of 14.7%.…”

“…Whilst this may have introduced some heterogeneity to the results, we expect that this limitation would not change the significance of failure for each surgeon grade, as bias should apply across all surgeon groups and it is reassuring that the overall failure rate from each data source was similar. Secondly, as with previous studies, 3,15,24 we used the absence of further RD surgery recorded on the EMRs as the indicator of success but some cases may have re-detached and the patient chose to decline a second operation or may have attended another center for repeat surgery. As untreated recurrent RD is associated with a high risk of serious visual impairment, 3 we expect the overwhelming majority of patients elect to undergo repeat RD surgery and furthermore most contributing centres are the only providers of vitreoretinal surgery to their local communities.…”

“…The Royal College of Ophthalmologists has recommended primary RD success rate as one of the benchmark indicators for fitness to practise vitreoretinal surgery, although to date no acceptable boundaries for case mix adjusted RD success rates have been defined. 9 Several studies have documented the success rate of primary RD surgery [10][11][12][13][14][15][16][17][18][19][20] but few have analysed inter-surgeon variation and those that did included only experienced surgeons 16 or a few centres reporting only one technique: PPV. [17][18][19] The UK National Health Service (NHS) provides an ideal environment for "real-world" studies of vitreoretinal surgery outcomes.…”