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

Figures & data

Table 1 Patient characteristics: demographics

Sex	n (%)
Male	131 (68)
Female	62 (32)
Age, years	52.2±17.7
Age distribution	n (%)
≤17-year-old	8 (4)
18–50-year-old	68 (35)
≥50-year-old	117 (61)

Table 2 Patient characteristics: medical comorbidities

Comorbidity	n (%)
Hypertension	60 (31)
Coronary artery disease	18 (9)
Congestive heart failure	3 (2)
Arrhythmia	6 (3)
Diabetes mellitus	17 (9)
Lung disease	15 (8)
Transient ischemic attack	2 (1)
Stroke	0 (0)
Chronic renal failure	4 (2)
Cancer (all)	20 (10)
Smoking history^a
Current smoker	13 (7)
Prior smoker	43 (22)
Never smoker	132 (68)

Note: ^aSmoking history unknown in 5 cases.

Table 3 Preoperative clearance

Overall	n (%)
Cleared	69 (36)
Not cleared	124 (64)
By age group	n (%)
Cleared, age≤17-year-old	8 (100)
Cleared, age, 18–50-year-old	24 (35)
Cleared, age≥50-year-old	37 (32)
By macula status^a	n (%)
Cleared, macula-on	21 (27)
Cleared, macula-off	48 (41)

Note: ^aP<0.05 using chi-squared test (Prism 6) comparing macula-on and macula-off cases with or without preoperative clearance.

Table 4 Relationship between preoperative comorbidities and characteristics and any intraoperative and postoperative adverse events

Preoperative comorbidity	OR	95% CI of OR	P-value
Hypertension	1.54	0.48–4.56	0.56
Cardiac disease (all)^a	3.48	0.86–11.7	0.06
Coronary artery disease	1.64	0.22–6.81	0.64
Chronic heart failure	24.5	1.88–802	0.02
Arrhythmia	6.77	0.78–40.6	0.07
Lung disease	2.05	0.27–8.73	0.33
Diabetes	0.81	0.03–4.54	1.00
Preoperative characteristic	OR	95% CI of OR	P-value
Age, years	1.01	0.98–1.04	0.63
Sex^b	1.08	0.31–3.23	1.00
Smoking history
Current smoker	2.92	0.37–14.0	0.26
Prior smoker	1.61	0.40–5.54	0.26
History of anticoagulant use^c	6.77	0.78–40.6	0.07
General anesthesia	9.56	3.11–33.4	<0.001
Preoperative medical clearance	1.64	0.54–4.85	0.52

Notes: Adverse events defined as all intraoperative and postoperative systemic and ocular complications. All patients with complications had no history of chronic renal failure or malignancy. No patients in cohort presented with history of stroke. ^aAll patients with history of at least one of following conditions: coronary artery disease, myocardial infarction, congestive heart failure, arrhythmia, or other structural or valvular heart disease. ^bDenotes odds ratio of being female relative to being male. ^cHistory of anticoagulant use refers to documented history of taking any anticoagulation agent (ie, warfarin or non-vitamin K antagonist oral anticoagulants, NOACs) prior to surgery. The retrospective review was limited in its ability to reveal if, and for how long, anticoagulation agents were held prior to operations.

Table S1 Preoperative assessment characteristics

Macula status	n (%)
Macula-on	77 (40)
Macula-off	116 (60)
Average time from diagnosis to surgery, Mac on (days)	4±9
Median	1
Mode	0
Average time from diagnosis to surgery, Mac off (days)	6±13
Median	1
Mode	1
Initial encounter setting^a
Clinic	152 (79)
Emergency room	36 (19)
In-patient	3 (2)

Note: ^aEncounter setting unknown in 2 cases.

Table S2 Surgical characteristics

Surgery type	n (%)
Pars plana vitrectomy (PPV)	132 (68)
Scleral buckle (SB)	40 (21)
SB+PPV	21 (11)
Anesthesia used	n (%)
General anesthesia	40 (21)
Monitored anesthesia care	153 (79)
Type of block used	n (%)
None	35 (18)
Retrobulbar	140 (73)
Subtenon	4 (2)
Peribulbar	14 (7)

Table S3 Intraoperative adverse events or complications

Intraoperative complications	n (%)
Bradycardia or tachycardia^a	4 (2)
Hypotension^b	4 (2)
Hypertension^c	2 (1)
Arrhythmia	0 (0)
Myocardial infarction	0 (0)
Congestive heart failure flare	0 (0)
Desaturation	0 (0)
Respiratory complications	0 (0)
Respiratory failure^d	0 (0)
Stroke/CVA	0 (0)
Hypoglycemia	0 (0)
Hyperglycemia	1 (0.5)
Inability to extubate (general anesthesia cases)	0 (0)
Postoperative hospitalizations	0 (0)
Death	0 (0)

Notes: ^aBradycardia or tachycardia requiring intervention. ^bHypotension defined as BP<100 systolic with symptoms or requiring intervention. ^cHypertension requiring intervention. ^dRespiratory failure requiring ventilation.

Table S4 Other associated complications

Ocular complications	n (%)
Intraoperative^a	1 (0.5)
Postoperative^b	1 (0.5)
Systemic complications	n (%)
Postoperative^c	2 (1)

Notes: ^aIntraoperative ocular complication was choroidal hemorrhage. ^bPostoperative ocular complication was vitreous hemorrhage. ^cPostoperative systemic complications (2) were fevers with myalgias (1) and deep vein thrombosis and pulmonary embolism (1).