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Forte PA, Brousset G, Varenne F, Fournié P, Soler V, Pagot-Mathis V. [Limitations of outpatient vitreoretinal surgery at the Toulouse University hospital between 2016 and 2020: Causes for traditional hospitalization]. J Fr Ophtalmol 2023; 46:908-915. [PMID: 37625994 DOI: 10.1016/j.jfo.2023.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 03/31/2023] [Indexed: 08/27/2023]
Abstract
INTRODUCTION Currently, the majority of patients undergoing vitreoretinal surgery (VRS) are managed on an outpatient basis; this has been made possible by major surgical and anesthetic advances over the past decades. Nevertheless, the conversion to "all outpatient" surgery still poses some problems that are interesting to identify, and traditional hospitalization remains the solution in many situations. METHODS All patients undergoing VRS at the Toulouse University Hospital between 2016 and 2020 were included retrospectively. For each patient, we analyzed the entire medical, anesthesia and demographic records. We performed a simple descriptive analysis of all parameters studied, followed by a bi-variate analysis between the "Outpatient/Hospitalization" parameter and all other parameters. RESULTS Three thousand patients were included over the study period; 79.4% of patients were managed on an outpatient basis compared to 20.6% by traditional hospitalization. Failure of ambulatory care was the cause of 41.9% of the traditional hospitalizations, with the absence of an accompanying person on the evening of the surgery being the main reason (47.8%). DISCUSSION Social isolation is found to be one of the main causes of failure of ambulatory care; improvements might be made at this level, in order to reduce the burden on the inpatient hospital system.
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Affiliation(s)
- P-A Forte
- Service ophtalmologie, unité rétine, CHU de Toulouse Purpan, place du Docteur-Baylac, 31059 Toulouse, France.
| | - G Brousset
- Service ophtalmologie, unité rétine, CHU de Toulouse Purpan, place du Docteur-Baylac, 31059 Toulouse, France
| | - F Varenne
- Service ophtalmologie, unité rétine, CHU de Toulouse Purpan, place du Docteur-Baylac, 31059 Toulouse, France
| | - P Fournié
- Service ophtalmologie, unité rétine, CHU de Toulouse Purpan, place du Docteur-Baylac, 31059 Toulouse, France
| | - V Soler
- Service ophtalmologie, unité rétine, CHU de Toulouse Purpan, place du Docteur-Baylac, 31059 Toulouse, France
| | - V Pagot-Mathis
- Service ophtalmologie, unité rétine, CHU de Toulouse Purpan, place du Docteur-Baylac, 31059 Toulouse, France
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Cillino S, Iggui A, Di Naro S, Cillino G, Matranga D, Mazzucco W, Pojero F, Casuccio A. Determinants of inappropriate hospitalization in cataract surgery in the south of Italy: a retrospective study. Int Ophthalmol 2018. [PMID: 29520514 DOI: 10.1007/s10792-018-0887-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To analyze the frequency of inappropriate hospitalization in cataract surgery and the type of related determinants. METHODS A nested retrospective case-control study was carried out on 2708 consecutive cataract surgery patients operated between January 2013 and December 2015. All cases with inappropriate hospitalization (day surgery or ordinary hospitalization) were compared with a control group of cases treated in an appropriate (day service) regimen. The predictive value for inappropriate admissions to the hospital was assessed using a logistic regression model. Significant variables from the univariate analysis were included in a multivariate model. RESULTS Forty-five cases (< 2%) of inappropriate hospital admissions were recorded. Residence, heart disease, tremors, anticoagulants, intraoperative floppy iris syndrome were not related to appropriateness, while psychotic disorder (OR 12.571, p = 0.018), anxiety-depressive syndrome (OR 7.818, p = 0.010) and use of antipsychotropic drugs (OR 7.724, p = 0.002) were related to the inappropriateness of admission by univariate and multivariate analysis. Previous systemic surgeries were predictors of ordinary hospitalization by logistic regression analysis. A greater presence of hypertension, diabetes mellitus and fellow eye pseudophakia was noticed in appropriate hospitalization cases. CONCLUSIONS This study detects the predictive role of psychiatric disorders as determinants of hospitalization inappropriateness in cataract surgery. The negative correlation between inappropriate hospitalization and conditions such as hypertension and diabetes points out that in the elderly population common diseases are effectively addressed, in contrast to the difficult management of psychiatric patients. Prior systemic interventions represent factors inducing transfer from day service to ordinary hospitalization, highlighting communication problems related to difficult coping with an outpatient surgery setting.
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Affiliation(s)
- Salvatore Cillino
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section, University of Palermo, via Liborio Giuffrè, 13, 90127, Palermo, Italy.
| | - Aissa Iggui
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section, University of Palermo, via Liborio Giuffrè, 13, 90127, Palermo, Italy
| | - Simona Di Naro
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section, University of Palermo, via Liborio Giuffrè, 13, 90127, Palermo, Italy
| | - Giovanni Cillino
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section, University of Palermo, via Liborio Giuffrè, 13, 90127, Palermo, Italy
| | - Domenica Matranga
- Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", University of Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Walter Mazzucco
- Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", University of Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Fanny Pojero
- Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", University of Palermo, Via del Vespro 127, 90127, Palermo, Italy
| | - Alessandra Casuccio
- Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", University of Palermo, Via del Vespro 127, 90127, Palermo, Italy
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