Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.
Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina, USA.
BMJ Open. 2021 Mar 17;11(3):e038565. doi: 10.1136/bmjopen-2020-038565.
To identify factors that contribute to missed cataract surgery follow-up visits, with an emphasis on socioeconomic and demographic factors.
In this retrospective cohort study, patients who underwent cataract extraction by phacoemulsification at Massachusetts Eye and Ear between 1 January and 31 December 2014 were reviewed. Second eye cases, remote and international patients, patients with foreign insurance and combined cataract cases were excluded.
A total of 1931 cases were reviewed and 1089 cases, corresponding to 3267 scheduled postoperative visits, were included. Of these visits, 157 (4.8%) were missed. Three (0.3%) postoperative day 1, 40 (3.7%) postoperative week 1 and 114 (10.5%) postoperative month 1 visits were missed. Age<30 years (adjusted OR (aOR)=8.2, 95% CI 1.9 to 35.2) and ≥90 years (aOR=5.7, 95% CI 2.0 to 15.6) compared with patients aged 70-79 years, estimated travel time of >2 hours (aOR=3.2, 95% CI 1.4 to 7.4), smokers (aOR=2.7, 95% CI 1.6 to 4.8) and complications identified up to the postoperative visit (aOR=1.4, 95% CI 1.0 to 2.1) predicted a higher rate of missed visits. Ocular comorbidities (aOR=0.7, 95% CI 0.5 to 1.0) and previous visit best-corrected visual acuity (BCVA) of 20/50-20/80 (aOR=0.4, 95% CI 0.3 to 0.7) and 20/90-20/200 (aOR=0.4, 95% CI 0.2 to 0.9), compared with BCVA at the previous visit of 20/40 or better, predicted a lower rate of missed visits. Gender, race/ethnicity, language, education, income, insurance, alcohol use and season of the year were not associated with missed visits.
Medical factors and demographic characteristics, including patient age and distance from the hospital, are associated with missed follow-up visits in cataract surgery. Additional studies are needed to identify disparities in cataract postoperative care that are population-specific. This information can contribute to the implementation of policies and interventions for addressing them.
确定导致白内障手术随访失约的因素，重点关注社会经济和人口统计学因素。
在这项回顾性队列研究中，对 2014 年 1 月 1 日至 12 月 31 日在马萨诸塞州眼耳医院接受白内障超声乳化摘除术的患者进行了回顾。排除双眼病例、远程和国际患者、有外国保险的患者以及合并白内障的病例。
共回顾了 1931 例病例，其中 1089 例（3267 例预约术后就诊）符合纳入标准。在这些就诊中，有 157 例（4.8%）失约。有 3 例（0.3%）错过了术后第 1 天、40 例（3.7%）错过术后第 1 周和 114 例（10.5%）错过术后第 1 个月的就诊。与 70-79 岁年龄组相比，年龄<30 岁（校正优势比[aOR]为 8.2，95%置信区间[CI]为 1.9 至 35.2）和≥90 岁（aOR 为 5.7，95%CI 为 2.0 至 15.6）、估计旅行时间超过 2 小时（aOR 为 3.2，95%CI 为 1.4 至 7.4）、吸烟者（aOR 为 2.7，95%CI 为 1.6 至 4.8）和术后就诊时发现的并发症（aOR 为 1.4，95%CI 为 1.0 至 2.1）预测失约率更高。眼部合并症（aOR 为 0.7，95%CI 为 0.5 至 1.0）和前一次就诊最佳矫正视力（BCVA）为 20/50-20/80（aOR 为 0.4，95%CI 为 0.3 至 0.7）和 20/90-20/200（aOR 为 0.4，95%CI 为 0.2 至 0.9），与前一次就诊时的 BCVA 为 20/40 或更好相比，预测失约率较低。性别、种族/民族、语言、教育、收入、保险、饮酒和当年的季节与失约就诊无关。
医疗因素和人口统计学特征，包括患者年龄和与医院的距离，与白内障手术后的随访失约有关。需要进一步研究以确定白内障术后护理方面的特定人群差异。这些信息有助于实施政策和干预措施来解决这些问题。
