Clinical Ophthalmology (Sep 2019)
Assessing the value of preoperative medical clearance in patients with primary rhegmatogenous retinal detachment
Abstract
Rolake O Alabi1, Zachary A Turnbull2, Peter G Coombs1, Yiyuan Wu3, Anton Orlin1, RV Paul Chan4, Szilard Kiss1, Donald J D’Amico1, Mrinali P Gupta1 1Department of Ophthalmology, Weill Cornell Medical College, New York, NY, USA; 2Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA; 3Division of Biostatistics and Epidemiology, Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, NY, USA; 4Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USACorrespondence: Mrinali P GuptaDepartment of Ophthalmology, Weill Cornell Medical College, 1305 York Avenue, New York, NY 10021, USATel +1 646 962 2217Fax +1 646 962 0600Email [email protected]: To determine rates of intraoperative and postoperative systemic and ocular adverse events and establish the value of preoperative medical assessment in patients undergoing surgery for primary rhegmatogenous retinal detachment repair at a single academic center.Patients and methods: Retrospective cohort study of 185 patients undergoing surgery for repair of primary rhegmatogenous retinal detachment (RRD) at a single academic center. Medical records were reviewed for medical comorbidities, completion of preoperative medical examination, anesthesia used during surgery, intraoperative adverse medical events, intraoperative ocular complications, and systemic and ocular postoperative complications. The main outcome of interest was the association of comorbidities and preoperative medical evaluation with intraoperative and postoperative complications.Results: Approximately 48% of the patients presented with no medical comorbidities of interest. Formal preoperative evaluation by an independent medical provider was completed in 36% of the patients. Overall, intraoperative and postoperative systemic complications (5.7% and 1%, respectively) and intraoperative and postoperative ocular complications (0.5% for both) were uncommon. Patients with a history of chronic heart failure (OR 24.5, P=0.02) or who received general anesthesia (OR 9.56, P<0.001) had increased risk of having experienced any intraoperative or postoperative complication. No relationship between preoperative medical evaluation and intraoperative and postoperative complications was observed.Conclusion: Patients undergoing surgery for RRD repair presented with fewer medical comorbidities than previously reported in patients undergoing all vitreoretinal surgeries. Intraoperative and postoperative complications were uncommon and were increased in patients with chronic heart failure or who received general anesthesia. Complications were not significantly associated with preoperative evaluation by an independent medical provider.Keywords: vitreoretinal surgery, retinal detachment, preoperative assessment, preoperative medical testing, adverse medical events, postoperative systemic adverse events
