Assessing surgical quality according to rates for return to the operating room (ROR) may not be a consistently accurate measure across the spectrum of procedures and medical emphases, according to a study published in American Journal of Ophthalmology. The researchers examined unplanned ROR after primary retinal detachment (RD) surgeries.
“Recently, a 45-day ROR metric was proposed to assess postoperative ROR events across all surgical specialties at a tertiary care academic medical center,” the analysis explains. However, this metric has not yet been tested for suitability in evaluating outcomes of retinal detachment (RD) repair. While previous studies have explored factors leading to ROR, this investigation assesses duration from primary rhegmatogenous RD surgery to ROR; in ≤45 days, or ≥46 days.
The retrospective study assessed outcomes for 268 patients receiving 270 RD surgeries. They were performed from January 1, 2012 to June 30, 2014, with a median follow-up time of 411.5 days. Procedures included pars plana vitrectomy (PPV), scleral buckle (SB), and combined PPV/SB. In the total sample, 51.5% of ROR incidences happened during the first 45 days, and mean time to ROR was 70.9 days.
Trauma or proliferative vitreoretinopathy (PVR) were involved in 82 complicated RD procedures. In this cohort, cumulative ROR rate during follow-up was 14.6%. Half, or 50.0% of the incidences happened within 45 days, and mean time to ROR was 75.0 days. Risk factors that sent members of this group back to the OR included: open-globe (P <.0001), trauma-associated RD (P =.0011), high myopia (P =.021), clock hours detached (P =.023), PPV with silicone oil tamponade (P =.0280), and history of choroidal detachment (P =.053).
Unexpectedly, in the complicated RD group 2 factors were protective: number of retinal breaks (P =.018), and increased age at presentation (P =.019) were significantly linked to reduced chance of returning to surgery. The analysis speculates that older individuals may experience age-related difficulties which hinder them from pursuing additional care. Further, with added retinal breaks, there may have been a more “aggressive” approach to the repair, reducing risk for ROR.
Uncomplicated detachments — no associated trauma or PVR — were repaired in 188 patients. Cumulative rate of ROR in the follow-up period was 11.2%, with 52.4% of these occurring in the first 45 days. Mean time to ROR in this cohort was 68.6 days. For uncomplicated detachments, no statistically significant risk factors leading to ROR emerged.
Because this investigation was undertaken at a single tertiary center — including a greater percentage of complex cases, and specific exclusion criteria such as PDR — results may not be generalizable to all individuals undergoing surgery for rhegmatogenous RD. Conversely, the study’s strengths include a follow-up period of at least 90 days, and its retrospective design precluded bias in the decision whether to operate again.
“Although vitreous hemorrhage and postoperative wound complications can occur in retinal surgery, poor surgical outcomes can also result from a progression of a retinal disease state (eg, PVR) rather than a surgical complication or a lapse in intraoperative surgical quality,” the research explains.
Grosinger AJ, Nicholson BP, Shah SM, et.al. Time to unplanned return to the operating room and associated risk factors in patients with surgical retinal detachment repair. Am J Ophthalmol. Published online February 21, 2021;229:18–25. doi:10.1016/j.ajo.2021.02.016