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Atención diaria versus cirugía hospitalaria de catarata según la edad

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Referencias

Referencias de los estudios incluidos en esta revisión

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Castells 2001 {published data only}

Castells X, Alonso J, Castilla M, Ribo C, Cots F, Anto J. Outcomes and costs of outpatient and inpatient cataract surgery: a randomised clinical trial. Journal of Clinical Epidemiology 2001;54(1):23‐9.

Galin 1981 {published data only}

Galin MA, Boniuk V, Obstbaum SA, Barasch KR, Baras I. Hospitalization and cataract surgery. Annals of Ophthalmology 1981;13(3):365‐7.

Referencias de los estudios excluidos de esta revisión

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Cabric 2014 {published data only}

Cabric E, Zvornicanin J, Jusufovic V. The safety and efficacy of day care cataract surgery. Medicinski Arhiv 2014;68(2):117‐20.

Ingram 1980 {published data only}

Ingram RM, Banerjee D, Traynar MJ, Thompson RK. Day‐case cataract surgery. Transactions of the Ophthalmological Societies of the UK 1980;100(Pt 1):205‐9.

Lowe 1992 {published data only}

Lowe KJ, Gregory DA, Jeffery RI, Easty DL. Suitability for day case cataract surgery. Eye 1992;6(Pt 5):506‐9.

Percival 1992 {published data only}

Percival SP, Setty SS. Prospective audit comparing ambulatory day surgery with inpatient surgery for treating cataracts. Quality in Health Care 1992;1(1):38‐42.

Rose 1999 {published data only}

Rose K, Waterman H, Toon L, McLeod D, Tullo A. Management of day‐surgery patients with cataract attending a peripheral ophthalmic clinic. Eye 1999;13(Pt 1):71‐5.

Ahmed 2011

Ahmed M, Nawaz M, Javed EA, Sultan M. Impact of day care surgery on in‐patient surgery for age‐related cataract in Faisalabad. Pakistan Journal of Medical and Health Sciences 2011;5(4):727‐30.

Black 2009

Black N, Browne J, van der Meulen J, Jamieson L, Copley L, Lewsey J. Is there overutilisation of cataract surgery in England?. British Journal of Ophthalmology 2009;93(1):13‐7.

Castells 2000

Castells X, Alonso J, Castilla M, Comas M. Efficacy and cost of ambulatory cataract surgery: a systematic review. Medicina Clinica 2000;114 Suppl 2:40‐7.

Cataract Surgery Registry Malaysia 2002

Cataract Surgery Registry. www.acrm.org.my/ned/cataractSurgeryRegistry.html (accessed 3 June 2015).

Cillino 2007

Cillino S, Casuccio A, Di Pace F, Pillitteri F, Cillino G, Lodato G. Day care cataract surgery in Central and Southern Italy: a multicentric survey. BMC Health Services Research 2007;7:16.

Cresswell 1996

Cresswell PA, Allen ED, Tomkinson J, Chapman FM, Pickering S, Donaldson LJ. Cost effectiveness of a single‐function treatment center for cataract surgery. Journal of Cataract and Refractive Surgery 1996;22(7):940‐6.

Desai 1999

Desai P, Minassian DC, Reidy A. National cataract surgery survey 1997‐8: a report of the results of the clinical outcomes. British Journal of Ophthalmology 1999;83(12):1336‐40.

Glanville 2006

Glanville JM, Lefebvre C, Miles JN, Camosso‐Stefinovic J. How to identify randomized controlled trials in MEDLINE: ten years on. Journal of the Medical Library Association 2006;94(2):130‐6.

Higgins 2003

Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ 2003;327(7414):557‐60.

Higgins 2011

Higgins JPT, Altman DG, Sterne JAC. Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.

Kupfer 1994

Kupfer C. The International Agency for the Prevention of Blindness. American Journal of Ophthalmology 1994;7(2):253‐7.

Limburg 1996

Limburg H, Kumar R, Bachani D. Monitoring and evaluating cataract intervention in India. British Journal of Ophthalmology 1996;80(11):951‐5.

Limburg 1997

Limburg H, Kumar R, Indrayan A, Sundaram KR. Rapid assessment of prevalence of cataract blindness at district level. International Journal of Epidemiology 1997;26(5):1049‐54.

Limburg 2009

Limburg H, Silva JC, Foster A. Cataract in Latin America: findings from nine recent surveys. Revista Panamericana de Salud Pública 2009;25(5):449‐55.

Mavrikakis 2006

Mavrikakis I, Georgiou T, Paul B, Liu CSC. Cataract surgery by appointment ‐ a pilot study. BMC Ophthalmology 2006;6(18):1‐5.

Minassian 1990

Minassian DC, Mehra V. 3.8 million blinded by cataract each year: projections from the first epidemiological study of the incidence of cataract blindness in India. British Journal of Ophthalmology 1990;74(6):341‐3.

Mojon‐Azzi 2007

Mojon‐Azzi SM, Mojon DS. The rate of outpatient cataract surgery in ten European countries: an analysis using data from SHARE survey. Graefes Archive for Clinical and Experimental Ophthalmology 2007;245(7):1041‐4.

Müller 2011

Müller A, Zerom M, Limburg H, Ghebrat Y, Meresie G, Fessahazion K, et al. Results of a rapid assessment of avoidable blindness (RAAB) in Eritrea. Ophthalmic Epidemiology 2011;18(3):103‐8.

RevMan 2014 [Computer program]

The Nordic Cochrane Centre. The Cochrane Collaboration. Review Manager (RevMan). Version 5.3. Copenhagen: The Nordic Cochrane Centre. The Cochrane Collaboration, 2014.

Riaz 2006

Riaz Y, Mehta JS, Wormald R, Evans JR, Foster A, Ravilla T, et al. Surgical interventions for age‐related cataract. Cochrane Database of Systematic Reviews 2006, Issue 4. [DOI: 10.1002/14651858.CD001323.pub2]

Rosenberg 2008

Rosenberg EA, Sperazza LC. The visually impaired patient. American Family Physician 2008;77(10):1431‐6.

Schulz 1995

Schulz KF, Chalmers I, Hayes RJ, Altman DG. Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 1995;273(5):408‐12.

Shickle 2015

Shickle D, Farragher TM. Geographical inequalities in uptake of NHS‐funded eye examinations: small area analysis of Leeds, UK. Journal of Public Health 2015;37(2):337‐45.

Simons 2009

Simons M, Gluckman P, Mayhew L, Iny I, Lawrence D. Care needs assessment: eye health. Public Health Action Support Team report for Tower Hamlets Borough Council (accessed 1 October 2014).

Steinberg 1994

Steinberg EP, Tielsch JM, Schein OD, Javitt JC, Sharkey P, Cassard SD, et al. National study of cataract surgery outcomes. Variation in 4‐month postoperative outcomes as reflected in multiple outcome measures. Ophthalmology 1994;101(6):1131‐40.

Sterne 2011

Sterne JAC, Egger M, Moher D. Chapter 10: Addressing reporting biases. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Intervention. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.

Tey 2007

Tey A, Grant B, Harbison D, Sutherland S, Kearns P, Sanders R. Redesign and modernisation of an NHS cataract service (Fife 1997‐2004): multifaceted approach. BMJ 2007;334(7585):148‐51.

Thylefors 1998

Thylefors B. A global initiative for the elimination of avoidable blindness. American Journal of Ophthalmology 1998;125(1):90‐3.

WHO 1997

World Health Organization. Global initiative for the elimination of avoidable blindness. www.who.int/blindness/Vision2020_report.pdf (accessed 29 September 2015).

Xiao 2010

Xiao B, Kuper H, Guan C, Bailey K, Limburg H. Rapid assessment of avoidable blindness in three counties, Jiangxi Province, China. British Journal of Ophthalmology 2010;94(11):1437‐42.

Referencias de otras versiones publicadas de esta revisión

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Fedorowicz 2005

Fedorowicz Z, Lawrence D, Gutierrez P. Day care versus in‐patient surgery for age‐related cataract. Cochrane Database of Systematic Reviews 2005, Issue 1. [DOI: 10.1002/14651858.CD004242.pub3]

Fedorowicz 2006

Fedorowicz Z, Lawrence DJ, Gutierrez P. A Cochrane systematic review finds no significant difference in outcome or risk of postoperative complications between day care and in‐patient cataract surgery. Saudi Medical Journal 2006;27(9):1296‐301.

Fedorowicz 2011

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. [DOI: 10.1002/14651858.CD004242.pub4]

Characteristics of studies

Characteristics of included studies [ordered by study ID]

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Castells 2001

Methods

Prospective unmasked randomised clinical trial
Allocation 1 month prior to surgery, concealment by central allocation

Participants

People with cataract from 3 public hospitals in Barcelona (Spain)
n = 1162. After randomisation, n = 1034 (out‐patients: n = 518, in‐patients: n = 516)
Withdrawals: 99. Completed trial: out‐patients 464 (89.6%), in‐patients 471 (91.3%)
Mean age (SD): day care 71.6 years (10.7), in‐patients 71.4 years (9.7)
Gender (female): day care: 270 (58.2%), in‐patients: 278 (59%)

Interventions

Extracapsular cataract extraction with intraocular lens implantation performed as day‐care and extracapsular cataract extraction with intraocular lens implantation performed in hospital

Outcomes

Postoperative surgical complications (24‐hour postoperative)
Late postoperative surgical complications (between 24 hours and 4 months)
Visual acuity of the operated and better eye 4 months postoperative, change in visual acuity pre‐postoperative

Notes

Only 17.5% of the day care and 16% of the in‐patients underwent phacoemulsification

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Quote: "The randomisation was generated by computerised simple random number software"

Comment: done

Allocation concealment (selection bias)

Low risk

Quote: "performed centrally by our research unit"

Comment: done

Blinding (performance bias and detection bias)
All outcomes

Unclear risk

Quote: "An unmasked randomised clinical trial"

Participants: not feasible

Healthcare providers: not feasible

Outcomes assessors and data analysts:

Quote: "the outpatient hospital group..were discharged home the same day after a visit by an ophthalmologist. They had an outpatient visit with an ophthalmologist 24h after surgery"

"In the inpatient hospital group, patients were admitted to an acute care hospital for at least one night after surgery and received hospital visit(s) by an ophthalmologist before hospital discharge"

Comment: while the masking of participants and healthcare providers may not have been feasible, the masking of outcomes assessors was possible and of significant importance in this trial. The trial report was unclear what steps were taken to limit the effects of performance bias

Incomplete outcome data (attrition bias)
All outcomes

Low risk

The report included a "trial randomisation flowchart"

Quote: "The results of the study have been analysed according to the intention to treat"

Comment: done

Selective reporting (reporting bias)

Low risk

All of the study's pre‐specified outcomes were reported

Other bias

Low risk

The study appeared to be free of other sources of bias
Galin 1981

Methods

Prospective randomised controlled trial

Participants

Country of origin: USA
n = 273, 23 refused. n = 250 age‐matched (aged 50‐79 years) people with cataracts, in‐patients: n = 82, day care: n = 168
No attritional losses over 2‐year follow‐up period

Interventions

Cataract extraction with or without a Sputnik intraocular lens

Randomised to hospital or hotel or immediate discharge to home

Outcomes

Duration and cost per day of stay in hospital or hotel reported

Notes

Data sparse largely narrative style

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Quote: "Using tables of coded random numbers"

Comment: done

Allocation concealment (selection bias)

Low risk

Quote: "The surgeon did not know preoperatively in which category a patient belonged." "On the day of surgery, the patient reported to the registration office at the hospital, where a hospital chart number was assigned". "At the end of the procedure, the eye was patched and we opened a sealed envelope that indicated the patient's postoperative location"

Comment: done

Blinding (performance bias and detection bias)
All outcomes

Unclear risk

Participants: not feasible

Healthcare providers: "The surgeon did not know preoperatively in which category a patient belonged"

Outcomes assessors and data analysts: it was unclear if the outcomes assessors, which may have included the surgeons, knew which of the participants had been hospitalised or had been assigned to day care, at the follow‐up assessment on the day after surgery

Comment: masking of assessors was 'unclear'

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Data sparse largely narrative style

Selective reporting (reporting bias)

Unclear risk

Quote: the objectives of the study were, "cataract patients were studied to determine if hospitalization was required for cataract extraction"

Comment: 'ocular results' and postoperative complications were not specified. The report did not include the results for these key outcomes that would be expected to have been reported

Other bias

Unclear risk

Insufficient information to assess whether an important risk of bias existed

n: number of participants; SD: standard deviation.

Characteristics of excluded studies [ordered by study ID]

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Study

Reason for exclusion

Cabric 2014

The study randomised people to a day care cataract surgery (DCCS) group and an out‐patient and in‐patient surgery group. The paper reported that, "All patients in DCCS group were discharged day after cataract extraction." We have excluded this study as participants were not treated as day care attendees

Ingram 1980

No intraocular lens implantation was carried out and study used the intracapsular cataract extraction technique, which is considered obsolete. Thus, the study cannot be relied on in a comparison with the current technique of extracapsular cataract extraction

Lowe 1992

This study only considered suitability for day case cataract surgery and did not include a comparison of in‐patient versus day case cataract surgery

Percival 1992

Unable to assess trial quality and unable to obtain further information from authors

Rose 1999

The study compared day stay participants in a peripheral clinic and a main eye hospital. All participants were treated as day stay

Study flow diagram.
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Figure 1

Study flow diagram.

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
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Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
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Figure 3

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Table 1. Visual acuity four months postoperative (operated eye)

Visual acuity

Number of participants (%)

Day care (total n = 464)

In‐patient (total n = 471)

< 6/18*

92 (19.8%)*

84 (17.8%)*

> 6/18 to 6/15

111 (24%)

128 (27.2%)

6/12 to 6/9

149 (32.1%)

161 (34.2%)

6/9

112 (24.1%)

98 (20.8%)

Mean change (SD)

4.1 (2.3)

4.1 (2.2)

*not primary outcomes.

n: number of participants; SD: standard deviation.
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Table 1. Visual acuity four months postoperative (operated eye)
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Table 2. Early (less than 24 hours) postoperative complications

Complications

Number of participants (%)

Risk ratio (95% CI)

Day care (total n = 464)

In‐patient (total n = 471)

Wound leakage

5 (1.1%)

4 (0.8%)

1.27 (0.34 to 4.77)

Corneal oedema

49 (10.6%)

36 (7.6%)

1.42 (0.91 to 2.24)

Intraocular pressure > 30 mm Hg

16 (3.4%)

5 (1.1%)

3.33 (1.21 to 9.16)

CI: confidence interval; n: number of participants.
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Table 2. Early (less than 24 hours) postoperative complications
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Table 3. Late (less than four months) postoperative complications

Complications

Number of participants (%)

Risk ratio (95% CI)

Day care (total n = 464)

In‐patient (total n = 471)

Corneal oedema

32 (6.9%)

24 (5.1%)

1.38 (0.80 to 2.38)

Wound leakage

4 (0.9%)

7 (1.5%)

0.76 (0.17 to 1.98)

Intraocular pressure > 30 mm Hg

3 (0.6%)

5 (1.1%)

0.61 (0.14 to 2.55)

Endophthalmitis

2 (0.4%)

0 (0.0%)

‐

CI: confidence interval; n: number of participants.
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Table 3. Late (less than four months) postoperative complications
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Table 4. VF14 scores four months postoperative

VF14 scores

Day care (n = 150)

In‐patient (n = 155)

Mean (SD) (range 0‐100)

92.8 (12.2)

87.6 (20.3)

Change score pre‐postoperative

25.2 (21.2)

23.5 (25.7)

n: number of participants; SD: standard deviation.
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Table 4. VF14 scores four months postoperative
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Table 5. Costs of cataract surgery

Costs

Day care (n = 150)

In‐patient (n = 155)

Total costs in Euros (SD)

1001.3 (251.4)

1218.0 (187.3)

n: number of participants; SD: standard deviation.
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Table 5. Costs of cataract surgery
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