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Inpatient cataract surgery has similar outcomes but is more costly than day-care cataract surgery

Lawrence D, Fedorowicz Z, van-Zuuren E  Day care versus in-patient surgery for age-related cataract  Cochrane Database of Systematic Reviews. 2015 November.

Review question

How does day-care cataract surgery compare to inpatient surgery in terms of cost-effectiveness, clinical outcomes, and/or patient satisfaction?

Background

There are some concerns over the quality of the service provided by day-care units and purpose-built centres for cataract surgery.

Daycare was initially introduced to contain costs, shorten wait times, and enable healthcare providers to perform more cataract surgeries in less time.

Initial concerns over the effectiveness of day-care cataract surgeries compared to inpatient surgeries have delayed their widespread use, and while there have been some studies that have compared the two procedures, an objective evaluation and comparison between the two is needed.

How the review was done

A detailed search of a number of electronic databases for studies published up until 2015 was conducted. Studies that compared day-care surgeries to inpatient surgeries and focused on the primary outcomes of visual acuity, the secondary outcomes of adverse effects, intraoperative and postoperative complications, quality of life, and economic data, were included in the review.

A total of 715 studies were identified in searches, and  two were included in the review after assessments for eligibility.

This review was funded by the National Institute for Health Research (NIHR) U.K.

What the researchers found

Patients’ vision four months after surgery was similar among those who received day-care surgery and inpatient surgery, while intraoperative complication data was unavailable.

While there was increased risk of postoperative pressure buildup within the eye in day-care surgeries the first day after surgery, this was not the case at four months. Results related to other complications were inconclusive.

Improvements in patient quality of life were similar in both interventions at four months, though it is suggested that participants preferred to recover at home. Costs were 20% higher in inpatient care due to overnight stays versus at-home recovery.

Conclusion

The review presents evidence of cost savings with day-care cataract surgeries when compared with inpatient cataract surgery. Effects on vision and quality of life appeared to be similar, but post-operative complication results were inconclusive. Future research that focuses on evidence provided by high quality clinical databases is needed to enable clinicians and healthcare planners to agree on clinical and social indications for inpatient care, and make better use of resources.