Resultados de un programa de cirugía mayor ambulatoria en oftalmología

Abstract

Purpose: To evaluate the outcomes in our hospital of an ambulatory major surgery program in patients with a variety of different ocular pathologies. Method: This retrospective study includes 13,878 patients who underwent programmed surgery by the Department of Ophthalmology between September 1998 and December 2004. Different ophthalmological surgical procedures were performed as outpatient surgery in 11,187 patients, with cataract surgery (phacoemulsification) being the most frequent operation performed (8,155 cases). We have analysed several indicators (substitution, suspension, admission and readmission rates), as well as surgical yield and systemic and ocular complications which appeared within 72 hours after surgery. The variables were measured as relative frequencies. The evolution of complications during the study period was analysed by the Chi-square trend test. Results: 13,878 patients had ophthalmic surgery during the study period; 11,187 had outpatient surgery with a global substitution ratio of 80.6%. The median surgical yield was 74.36%. The admission rate after surgery was 4.46% (499 patients), with 92.18% (460) of these requiring immediate admission. Twenty-one patients suffered from severe complications (cardiovascular, neurological, metabolic, infectious), representing a proportional risk of 1:532. Forty-five patients had less severe complications (arterial hypertension, nausea, vomiting, vasovagal syncope) that required admission to hospital. Ophthalmologic complications occurred in 79 cases (0.56%). Conclusions: Ambulatory major surgery (AMS) is an excellent organization model of multidisciplinary surgical assistance that makes it possible to treat well selected patients in an effective, safe and efficient manner. There is a low incidence of postoperative complications of variable severity despite following the optimum requisites, although fortunately mortality is practically absent.