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PUBLICATION EXCLUSIVE: Improvements in instruments, sterilization and anesthesia set stage for office-based vitreoretinal surgeries
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Remarkable advances in vitreoretinal surgery have occurred in the past 20 years. Diversified and miniaturized instruments have been produced, surgical time has dropped, and most procedures are done under local anesthesia, all of which have made hospitalization unnecessary in many cases. The number of vitreoretinal procedures performed in an outpatient setting has grown, and some surgeons feel that the time is about right to shift surgery to the office.
“There are currently 5,500 ambulatory surgical centers in the U.S. doing 25 million surgeries. We feel comfortable with it, at least in uncomplicated, routine cases,” Dante J. Pieramici, MD, said.
Pieramici’s group practice, California Retina Consultants, has 10 offices in different locations in California, and the doctors in the group operate in numerous ASCs and hospital-based ORs. They are outfitted with the best technology and specifically trained OR personnel. The vast majority of vitreoretinal procedures are performed under sedation and retrobulbar/peribulbar injection.
Image: Pieramici DJ
“The anesthesiologist is there to monitor sedation, and patients can usually be discharged 20 to 30 minutes after the procedure. Only a small minority of patients, about 5% to 10%, are referred to the hospital for general anesthesia, and only very rarely an overnight stay is needed,” Pieramici said.
Patients who may not qualify for ASC procedures include those with extreme coexisting medical conditions that can rapidly lead to life-threatening complications. ASCs do not have the most expedient emergency care and may require a hospital transfer in an ambulance in the case of a severe systemic complication. It is therefore advisable to have these patients operated on in a hospital-based setting; however, they are still done mostly on an outpatient basis, according to Pieramici.
“It happened in my practice. I had a patient who had an arrest during a vitreoretinal procedure. That’s why, if I foresee a possible risk, I prefer to operate on patients in a hospital where they can be revived by a code team and admitted immediately,” Pieramici said.
Another reason for hospital-based surgery and an overnight stay is lack of assistance and care at home.
“If patients don’t have someone to drive them home and to stay with them overnight at least for the first night, I make them stay. This is for their safety and to avoid medical-legal issues,” he said.
- Click here to read the full publication exclusive, Cover Story, published in Ocular Surgery News U.S. Edition, May 25, 2017.