Unplanned 30‐day readmission rate after ophthalmological surgery as a quality‐of‐care indicator

Abstract

BackgroundThe 30‐day readmission rate provides a standardised quantitative evaluation of some postoperative complications. It is widely used worldwide in many medical and surgical specialities, and the World Health Organization recommends its use for monitoring healthcare system performance. In ophthalmology, its measurement is biased by the frequent and close planned surgery on one eye and then the other, particularly in the case of cataract surgery. This study measures the 30‐day unplanned readmission rate in ophthalmology, globally and by surgery subtype, and describes the causes of readmission.MethodsAll patients readmitted within 30 days of ophthalmic surgery at Nantes University Hospital between January 2017 and December 2020 were identified in the Medical Information System. An ophthalmologist examined each medical record and collected the following data: the reason for readmission, comorbidities, the pathology treated, surgery type, surgery duration, the surgeon's experience, anaesthesia type, severity and readmission morbidity.ResultsFor the 8522 ophthalmic surgeries performed in the four‐year study period, 282 30‐day unplanned readmissions were identified. The overall 30‐day unplanned readmission rate was 2.07% for elective surgery, with a high variability depending on the surgery type: 0.95% for phacoemulsification, 4.95% for vitreoretinal surgery (3.42% for non‐elective vitreoretinal surgery, 5.44% for retinal detachment surgery), 5.66% for deep lamellar keratoplasty and 11.90% for trabeculectomy. The unplanned 30‐day readmission rate for ocular trauma surgery (emergency care) was 11.0%. Seven percent of all unplanned 30‐day readmissions were not associated with an ophthalmological problem.ConclusionsThis study is the first to report 30‐day unplanned readmission in ophthalmology, globally and by surgical subtype, for elective and urgent procedures. This indicator can be used longitudinally to detect an increase in risk or transversely to compare the quality of care between different public or private hospitals.

Healthcare quality indicators for value‐based reimbursement in ophthalmology

“…In conclusion, the study by Crozet et al (2024) could help us in setting up a reward system for providing highvalue care and incentivize for fewer postoperative complications, readmissions and lower-than-expected costs. By doing so, we could ease budgetary pressures associated with the ageing population, which is immediate in most countries experiencing a demographic transition.…”

“…Thus, data on quality of care, as provided by Crozet et al (2024) in this issue would benefit the patients who want to choose their healthcare provider based on the surgical outcomes, and in turn, it would also benefit physicians who provide good healthcare services.…”

“…Limitations to implementing data from studies such as that by Crozet et al (2024) may involve infrastructure requirements, including information technology, change resistance to the current policies, scarcity of appropriate patient reported outcomes in ophthalmology and wrong incentives (Feeley & Mohta, 2018;Joynt Maddox et al, 2022;Liao & Navathe, 2022;Zaki et al, 2021). Nevertheless, policy changes to improve the efficiency of healthcare costs are inevitable to balance the fiscal challenge.…”