Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Nov:219:132-140.
doi: 10.1016/j.ajo.2020.06.016. Epub 2020 Jun 20.

Unplanned Return to the Operating Room After Trabeculectomy

Nur Cardakli  1 , David S Friedman  2 , Michael V Boland  3
Affiliations

Unplanned Return to the Operating Room After Trabeculectomy

Nur Cardakli et al. Am J Ophthalmol. 2020 Nov.

Abstract

Purpose: To determine the unplanned return to operating room (OR) rate within 180 days and at any time postoperatively after trabeculectomy performed or supervised by an attending surgeon and to identify associated factors.

Design: Retrospective case-control study.

Methods: Review of 881 eyes that underwent trabeculectomy at an academic glaucoma service between January 2014 and December 2016. Inclusion criteria included adult patients with postoperative follow-up >180 days and no other glaucoma-related surgery within the prior year. For each eye that underwent reoperation, a control was time-matched within 1 month.

Results: The reoperation rate within 180 days was 9.5% (84/881) and at any time postoperatively was 23.3% (205/881). When intraoperative bleb needling cases were excluded, the reoperation rate was 6.5% (57/881) within 180 days and 13.6% (120/881) at any time postoperatively. Mean postoperative follow-up was 2.9 ± 1.1 years. The most common reoperations within 180 days were bleb revision (32.1%) and intraoperative bleb needling (28.6%) and at any time postoperatively were bleb needling (36.1%), bleb revision (23.9%), and tube shunt implant (13.2%). At last follow-up, eyes that returned to OR and control eyes were similar in terms of mean intraocular pressure (IOP), the proportion of eyes meeting target IOP, and change in visual acuity since the original trabeculectomy.

Conclusions: Nearly 10% of eyes returned to OR within 180 days and over 20% of eyes required reoperation at any time postoperatively with a mean follow-up of nearly 3 years. Additional studies should evaluate unplanned return to OR as a measure of surgical quality within ophthalmology.

PubMed Disclaimer

Figures

FIGURE 1.
FIGURE 1.
Timing of unplanned return to the operating room (OR). This graph depicts the stratification of reoperation rates early within the postoperative period. At any time during postoperative follow-up, 205 eyes (23.3%) returned to the OR. Of the 84 eyes (9.5%) that returned to the OR within the first 180 days, nearly half (4.5%) underwent reoperation within the first 90 days, with 20 eyes (2.2%) undergoing reoperation within the first 30 days.
FIGURE 2.
FIGURE 2.
Kaplan-Meier survival curve for unplanned return to the operating room (OR). Failure is defined as an unplanned return to the OR. At 1, 2, and 4 postoperative years, 86.9%, 81.8%, and 73.9% of trabeculectomy surgeries avoided unplanned return to the OR, respectively.
FIGURE 3.
FIGURE 3.
Reasons for unplanned return to the operating room (OR) by time after the original surgery. This graph shows the indications for return to OR stratified by the time period in which cases underwent unplanned reoperation. The most common reasons for unplanned return to OR, both within 180 days and at any time postoperatively, were persistently elevated intraocular pressure (IOP) refractory to medical therapy, bleb leak, hypotony, and choroidal effusion. Most cases that returned to the OR owing to postoperative choroidal effusion were early in the postoperative period. With longer time prior to reoperation, there were relatively more cases that underwent reoperation for persistently elevated IOP and hypotony than any other indication for return to OR.
See this image and copyright information in PMC

References

    1. Birkmeyer JD, Hamby LS, Birkmeyer CM, Decker MV, Karon NM, Dow RW. Is unplanned return to the operating room a useful quality indicator in general surgery? Arch Surg 2001;136(4):405–411. - PubMed
    1. Mukerji N, Jenkins A, Nicholson C, Mitchell P. Unplanned reoperation rates in pediatric neurosurgery: a single center experience and proposed use as a quality indicator. J Neurosurg Pediatr 2012;9(6):665–669. - PubMed
    1. Morris AM, Baldwin L-M, Matthews B, et al. Reoperation as a quality indicator in colorectal surgery: a population-based analysis. Ann Surg 2007;245(1):73–79. - PMC - PubMed
    1. Ploeg AJ, Lange CPE, Lardenoye J-W, Breslau PJ. The incidence of unplanned returns to the operating room after peripheral arterial bypass surgery and its value as indicator of quality of care. Vasc Endovascular Surg 2008;42(1):19–24. - PubMed
    1. Menda SA, Driver TH, Neiman AE, Naseri A, Stewart JM. Return to the operating room after resident-performed cataract surgery. JAMA Ophthalmol 2014;132(2):223–224. - PubMed

Publication types