Unplanned Return to the Operating Room After Tube Shunt Surgery

Abstract

Purpose: The purpose of this study was to determine the rate of unplanned returns to the operating room (OR) within 180 days and at any time postoperatively after valved and non-valved tube shunt surgery.

Design: Retrospective case-control study.

Methods: A review of 357 eyes that underwent tube shunt surgery (151 valved, 206 non-valved) was conducted at an academic glaucoma service between January 2014 and December 2016. A control eye was time matched for each eye that underwent reoperation.

Results: The reoperation rate within 180 days was 16 of 151 (10.6%) for valved and 25 of 206 (12.1%) for non-valved tube shunts and at any time postoperatively was 31 of 151 (20.5%) for valved, and 47 of 206 (22.8%) for non-valved tube shunts. Mean postoperative follow-up was 2.8 ± 1.1 years. The most common reoperations within 180 days and at any time postoperatively after valved tube shunt surgery were tube revisions (43.8% within 180 days, 38.7% any time) and external cyclophotocoagulation (CPC) (31.3% within 180 days, 38.7% anytime). The most common reoperations within 180 days after non-valved tube shunt surgery were tube revisions (32.0%), external CPC (12.0%), and vitrectomy with anterior chamber washout (12.0%) and at any time postoperatively were tube revision (34.0%), external CPC (31.9%), and tube explant (12.8%). At last follow-up, eyes that returned to the OR and controls were similar in terms of mean intraocular pressure (IOP), proportion of eyes meeting target IOP, and change in visual acuity.

Conclusions: More than 20% of eyes undergoing tube shunt surgery returned to the OR at any time postoperatively with a mean follow-up of nearly 3 years, with more than 10% of eyes undergoing reoperation within the first 180 days. Rates of reoperation were similar between valved and non-valved tube shunts.

Figure 1.. Cumulative rate of unplanned return to OR after tube shunt surgery.

This graph shows stratification of the cumulative rates of reoperation early in the postoperative period. Forty-seven (22.8%) eyes that underwent non-valved tube shunt and 31 (20.5%) eyes that underwent valved tube shunt returned to the operating room at any time postoperatively for an additional surgery related either to the patient’s glaucoma or a complication from the tube shunt surgery. Of the 25 (12.1%) non-valved tube shunts and 16 (10.6%) valved tube shunts that returned to the OR within the first 180 days, roughly three-quarters (9.7% non-valved, 7.9% valved) of the reoperations occurred within the first 90 days.

Figure 2.. Kaplan-Meier survival curve for unplanned return to the OR after tube shunt surgery.

Failure is defined as an unplanned return to the OR due to a progression of the patient’s glaucoma or a complication arising from the tube shunt surgery. At 1, 2, and 4 years postoperatively, 85.0%, 80.4%, and 78.6% of non-valved tube shunt implants and 86.1%, 83.9%, and 80.4% of valved tube shunt surgeries avoided reoperation. The survival curves for the non-valved and valved tube shunts did not significantly differ (p = 0.758).