Longer Cataract Surgeries More Likely to Require Emergency Care

Younger age, longer case length, type of anesthesia, and insurance status can all increase a patient’s odds of requiring an emergency department (ED) visit after cataract surgery, according to a study published in the American Journal of Ophthalmology. However, ocular reasons for ED visits after cataract surgery are rare and result in the lowest hospital cost compared with other reasons, according to the study.

In this single-institution retrospective study, researchers reviewed data on all patients who underwent cataract surgery at Duke health facilities from July 2013 to December 2021 to report the rate, reasons, and hospital costs of ED visits within 30 days of cataract surgery and determine which patient factors increase odds of ED visits after surgery.

A total of 57,656 eyes of 34,246 patients (mean age, 69±10.2 years; 59.6% women; 40.4% men) underwent cataract surgery during the study period. Many of the cases were completed with monitor anesthesia care (MAC; 98.7%). ED visits within 30 days of surgery occurred for 607 patients (1.77%), with the most common reason being cardiovascular (24.4%) followed by other (16.5%) then ocular reasons (15.4%). The 5 common diagnosis for ED patients with primary ocular complaints included: high intraocular pressure (15.4%), rebound iritis (14.4%), posterior vitreous detachment (12.5%), dysphotopsias (11.5%), and dry eye (10.6%). Many of the patients spoke with an on-call ophthalmologist prior to visiting the ED.

Younger patients face a higher risk of postoperative ED visits compared with patients older than 70 years (OR: 1.39 [1.16–1.65]; P <.001), according to the investigators. Procedures that last 30 minutes or longer (OR 2.1 [1.56 – 2.83]; P <.001), or used a combination of anesthesia types (OR: 2.98 [1.73–5.12]; P <.001) also were more likely than others to seek ED care. Patients with insurance (Medicare, private, or other) have a lower risk of ED visits compared with self-pay patients, according to the study authors.

In this study, the rates of postoperative ED visits within 30 day of surgery (1.77%), and for patients with ocular diagnoses (15%) were both low. 

“Only 1 of the 105 ED visits for ocular reasons resulted in a hospital admission. Therefore, institutions should not only be evaluating hospital admissions after cataract surgery as part of their quality assessments; ED visits form a more reliable indicator of unplanned healthcare utilization after cataract surgery,” the researchers explain. “The burden of postoperative visits after cataract surgery for true ocular causes is very minimal on the emergency healthcare system.”

The primary limitation of the study was its retrospective design and single institution experience, limiting generalizability to other hospitals and populations.