Vitreoretinal procedures should be treated as day cases

Patients who are currently hospitalized overnight for vitreoretinal surgery could safely be treated as day cases, thus providing significant improvements in efficiency, according to a report published in the February issue of Eye.

Vaughn Tanner and colleagues from the Royal Berkshire and Battle NHS trust, Windsor, UK conducted a retrospective and prospective study to examine the feasibility and safety of routine day case vitreoretinal surgery.

A total of 100 patients (50 retrospective and 50 prospective) undergoing vitreoretinal surgery within the Royal Berkshire NHS trust were included. The retrospective arm of the study aimed to identify the frequency and type of acute ophthalmic or medical intervention during a postoperative overnight stay and the results were used to alter management in the prospective group. The prospective arm included both patients staying overnight and day cases. All patients in the prospective group had routine subtenon marcaine anaesthesia together with prophylactic preoperative intravenous acetazolamide. Patients deemed fit postoperatively, were offered overnight ward discharge with obligatory next day review.

In the retrospective group, 56% required oral non-steroidal analgesia on the day of surgery and one patient required narcotic analgesia. Twenty-two percent of patients required intraocular pressure (IOP) control on the day of surgery and one patient needed medical intervention in the form of urinary catheterization. A total of 19 patients required intervention on next-day review. In the prospective group, 86% preferred day case and were suitable, 6% were suitable but preferred overnight stay and 8% were deemed unfit for discharge. No patient discharged returned as a casualty overnight and only one patient required a topical beta-blocker for the control of IOP on next-day review.

It was the conclusion of the authors that most vitreoretinal procedures could be treated as day cases, which would be less stressful for patients and better for efficiency.