Objective To evaluate changes in operational effectiveness after the implementation of ambulatory surgical management in pars plana vitrectomy(PPV).Methods A retrospective clinical study.17 528 surgeries in 10 895 eyes of 10 895 patients who underwent minimally invasive PPV on an ambulatory and/or inpatient basis at Tianjin Medical University Eye Hospital from August 2015 to June 2023 were included in this study.Among them,5 346 eyes in 5 346 cases were male;5 549 eyes in 5 549 cases were female.The age ranged from 0 to 95 years,with the mean age of(57.74±13.15)years.6 381 surgeries in 3 615 eyes from August 2015 to December 2018(the initial period of day surgery)were used as the control group;11 147 surgeries in 7280 eyes from January 2019 to June 2023(the expanded period of day surgery)were used as the observation group.According to the management mode of ambulatory surgery,the observation group was subdivided into the decentralized management group(January 2019 to December 2020)and the centralized management group(January 2021 to June 2023),with 2 905 and 4 375 eyes and 4 646 and 6 501 surgeries,respectively.Changes in the percentage of day surgery,average hospitalization days,and average unplanned reoperation rate were compared.The Mann-Whitney U test was used to compare numerical variables between groups;the chi-square test or Fisher's exact test was used to compare categorical variables.Results The number of cases of daytime PPV performed in the observation group and control group was 7 852(70.44％,7 852/11 147)and 24(0.38％,24/6 381)cases,respectively,and the average hospitalization days were 1(1)and 5(3)d.Compared with the control group,the observation group had a significantly higher percentage of day surgery(x2=8 051.01)and a considerably lower mean hospitalization day(Z=4 536 844.50),and the differences were statistically significant(P＜0.000 1).The mean hospitalization days in the decentralized and centralized management groups were 2(3)and 1(0)d,respectively,and unplanned reoperations were 34(0.73％,34/4 646)and 171(2.63％,171/6 501)eyes,respectively.Compared with the decentralized management group,average hospitalization days was significantly lower(Z=l 436.94)and unplanned reoperation rate was significantly higher(x2=54.10)were significantly lower in the centralized management group,both of which were statistically significant(P＜0.000 1).Conclusion PPV ambulatory management model can significantly reduce the average hospitalization day,but also results in higher rates of unplanned reoperations.
Ambulatory surgeryPars plana vitrectomyHospital managementReal-world study
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