Assessing the value of preoperative medical clearance in patients with primary rhegmatogenous retinal detachment

Abstract

Purpose

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

Supplementary materials

Table S1 Preoperative assessment characteristics

Table S2 Surgical characteristics

Table S3 Intraoperative adverse events or complications

Table S4 Other associated complications

Ethics approval and informed consent

This study was conducted after approval from the Institutional Review Board at Weill Cornell Medical College (New York, NY, USA). Individual patient consent was not required since this was a retrospective study and since all patient data were de-identified.

Acknowledgment

The authors would like to acknowledge the National Institutes of Health grant T32GM007739 to the Tri-Institutional MD-PhD program (ROA), the Clinical and Translational Science Center at Weill Cornell Medical College Grant 1-UL1-TR002384-01, and an unrestricted departmental grant from Research to Prevent Blindness (AO, DJD, SK, and MPG).

Disclosure

Dr Robison Vernon Paul Chan reports personal fees from Allergan, Alcon, Visunex Medical Systems, Beyeonics, and Genentech outside the submitted work. Dr Szilard Kiss reports personal fees and a stock grant from Adverum, and personal fees from Alcon, Optos, RegenXBio, BioMarin, Regeneron, Novartis, Genentech/Roche, and Fortress Bio during the conduct of the study. Dr Donald J. D’Amico reports grants from Research to Prevent Blindness, Inc. during the conduct of the study. The authors report no other conflicts of interest in this work.