Same day surgery compared to overnight stay for treatment of cataract caused by old age

Fedorowicz Z, Lawrence D, Gutierrez P, van Zuuren EJ

Published Online:

July 6, 2011

The lens in eyes can become cloudy with age, leading to blurry vision or total vision loss. Cataracts can be surgically removed using a process called phacoemulsification, followed by implantation of an artificial lens to restore vision. This method of surgery is quicker and together with a shorter recovery period has made the possibility of day surgery a reality. Two trials conducted in Spain and USA, involving a total of 1284 people, were included. The small number of trials in this review found that in developed countries at least, there is some evidence that day surgery for this type of cataract extraction may not only be cheaper but just as effective as hospitalisation and overnight stay for cataract extraction.

Abstract (click to read)

Background:

Age-related cataract accounts for more than 40% of cases of blindness in the world with the majority of people who are blind from cataract found in the developing world. With the increased number of people with cataract there is an urgent need for cataract surgery to be made available as a day care procedure.

Objectives:

To provide reliable evidence for the safety, feasibility, effectiveness and cost-effectiveness of cataract extraction performed as day care versus in-patient procedure.

Search strategy:

We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2011, Issue 5), MEDLINE (January 1950 to May 2011), EMBASE (January 1980 to May 2011), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to May 2011), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) and ClinicalTrials.gov (www.clinicaltrials.gov). There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 23 May 2011.

Selection criteria:

We included randomised controlled trials comparing day care and in-patient surgery for age-related cataract. The primary outcome was the achievement of a satisfactory visual acuity six weeks after the operation.

Data collection and analysis:

Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information. Adverse effects information was collected from the trials.

Main results:

We included two trials (conducted in Spain and USA), involving 1284 people. One trial reported statistically significant differences in early postoperative complication rates in the day care group, with an increased risk of increased intraocular pressure, which had no clinical relevance to visual outcomes four months postoperatively. The mean change in visual acuity (Snellen lines) of the operated eye four months postoperatively was 4.1 (standard deviation (SD) 2.3) for the day care group and 4.1 (SD 2.2) for the in-patient group and not statistically significant. The four-month postoperative mean change in quality of life score measured using the VF14 showed minimal differences between the two groups. Costs were 20% more for the in-patient group and this was attributed to higher costs for overnight stay. One study only reported hotel costs for the non-hospitalised participants making aggregation of data on costs impossible.

Authors' conclusions:

This review provides some evidence that there is a cost saving but no significant difference in outcome or risk of postoperative complications between day care and in-patient cataract surgery. This is based on one detailed and methodologically sound trial conducted in the developed world. The success, safety and cost-effectiveness of cataract surgery as a day care procedure appear to be acceptable. Future research may well focus on evidence provided by high quality clinical databases and registers which would enable clinicians and healthcare planners to agree clinical and social indications for in-patient care and so make better use of resources, by selecting day case surgery unless these criteria are met.

This record should be cited as:

Fedorowicz Z, Lawrence D, Gutierrez P, van Zuuren EJ. Day care versus in-patient surgery for age-related cataract. Cochrane Database of Systematic Reviews 2011, Issue 7. Art. No.: CD004242. DOI: 10.1002/14651858.CD004242.pub4

Assessed as up to date:

May 23, 2011

Find the research

Get full text at The Cochrane Library

Primary Review Group:

Eyes and Vision Group

Health topics:

Eyes & vision > Lens disease & cataract

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Same day surgery compared to overnight stay for treatment of cataract caused by old age

More like this

Copyright © 2011 - The Cochrane Collaboration