Service d'Ophtalmologie CHU Nantes, Ecole Centrale Nantes, LS2N, UMR6004, Nantes Université, Nantes, France.
Public Health Department, Nantes Université, CHU Nantes, Nantes, France.
Acta Ophthalmol. 2024 Aug;102(5):e789-e796. doi: 10.1111/aos.16641. Epub 2024 Feb 2.
The 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.
All 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.
For 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.
This 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.
30 天再入院率为某些术后并发症提供了标准化的定量评估。它在世界范围内的许多医学和外科专业中得到广泛应用，世界卫生组织建议将其用于监测医疗保健系统的绩效。在眼科学中，由于频繁且计划进行单眼和双眼手术，特别是白内障手术，因此其测量结果存在偏差。本研究测量了全球范围内和按手术亚型分类的眼科 30 天非计划性再入院率，并描述了再入院的原因。
在 2017 年 1 月至 2020 年 12 月期间，通过 Nantes 大学医院的医疗信息系统确定了 30 天内眼科手术后再入院的所有患者。一名眼科医生检查了每一份病历并收集了以下数据：再入院原因、合并症、治疗的病理学、手术类型、手术持续时间、手术医生的经验、麻醉类型、严重程度和再入院发病率。
在四年的研究期间进行的 8522 例眼科手术中，确定了 282 例 30 天非计划性再入院。择期手术的 30 天非计划性再入院总体发生率为 2.07%，手术类型的差异很大：超声乳化术为 0.95%、玻璃体视网膜手术为 4.95%（非择期玻璃体视网膜手术为 3.42%、视网膜脱离手术为 5.44%）、深层板层角膜移植术为 5.66%、小梁切除术为 11.90%。眼外伤手术（急诊）的 30 天非计划性再入院率为 11.0%。所有 30 天非计划性再入院的 7%与眼科问题无关。
本研究首次报告了全球范围内和按手术亚型分类的择期和紧急手术的眼科 30 天非计划性再入院情况。该指标可用于纵向检测风险增加，或用于横向比较不同公立或私立医院之间的护理质量。
