Atalla M L, Wells K K, Peucker N, Yi Q, McCarty D J, Louis D, Taylor H R
The Royal Victorian Eye and Ear Hospital and Centre for Eye Research Australia, East Melbourne, Victoria.
Clin Exp Ophthalmol. 2000 Apr;28(2):83-8. doi: 10.1046/j.1442-9071.2000.00277.x.
Cataract surgery is increasing in Australia and represents a significant burden on limited health resources. This study examines the frequency and outcomes of cataract surgery for patients who were hospitalized overnight compared with those treated as day surgery cases.
Medical records of 671 consecutive admissions for cataract surgery at the Royal Victorian Eye and Ear Hospital were reviewed. Data analysed included demographic features, insurance status, length of hospitalization, ophthalmic conditions, medical conditions, social problems and planned surgical technique. Ophthalmic and anaesthetic complications, active ophthalmic and medical interventions were also studied.
Of the 671 patient admissions for cataract during the study period, 226 (33.4%) were hospitalized overnight. Factors significantly associated with overnight hospitalization in univariate analyses include older age, female sex, country residence, Veterans' Affairs insurance, monocular vision status, pre-existing ischaemic heart disease, pre-existing asthma/chronic obstructive lung disease, absence of carer, transportation problems, planned extra-capsular cataract extraction technique, ophthalmic complications and active ophthalmic and/or medical interventions. After adjusting for possible confounding factors using backwards stepwise multivariate logistic regression models all except pre-existing ischaemic heart disease and ophthalmic complications were significantly associated with overnight admission for cataract surgery. In total, 14 cases (2.1%) needed active ophthalmic and/or medical interventions, 13 overnight cases and one day case.
These data suggest that many patients who are hospitalized overnight for cataract surgery could be safely treated as day cases. Such a shift in the pattern of care for cataract surgery could provide a significant potential for health care savings.
白内障手术在澳大利亚日益增多，给有限的卫生资源带来了巨大负担。本研究比较了需住院过夜的白内障手术患者与接受日间手术治疗的患者的手术频率及结果。
回顾了皇家维多利亚眼耳医院671例连续接受白内障手术患者的病历。分析的数据包括人口统计学特征、保险状况、住院时间、眼科疾病、内科疾病、社会问题及计划采用的手术技术。还研究了眼科及麻醉并发症、积极的眼科及内科干预措施。
在研究期间的671例白内障手术患者中，226例（33.4%）需住院过夜。单因素分析中与过夜住院显著相关的因素包括年龄较大、女性、居住在农村、退伍军人事务保险、单眼视力状态、既往有缺血性心脏病、既往有哮喘/慢性阻塞性肺疾病、无护理人员、交通问题、计划采用的白内障囊外摘除技术、眼科并发症以及积极的眼科和/或内科干预措施。使用向后逐步多因素逻辑回归模型对可能的混杂因素进行校正后，除既往有缺血性心脏病和眼科并发症外，所有因素均与白内障手术过夜住院显著相关。共有14例（2.1%）患者需要积极的眼科和/或内科干预措施，其中13例为过夜手术患者，1例为日间手术患者。
这些数据表明，许多因白内障手术住院过夜的患者可安全地作为日间手术病例治疗。白内障手术护理模式的这种转变可为节省医疗保健费用提供巨大潜力。
