What is the association of management of rhegmatogenous retinal detachment with the day of the week?
In this claims-based cohort study of 38 144 commercially insured US patients with incident rhegmatogenous retinal detachment between 2008 and 2016, rhegmatogenous retinal detachments repaired during the weekend were more likely to be repaired with pneumatic retinopexy, patients undergoing pneumatic retinopexy on Sundays were more likely to undergo reoperation, and patients who received a diagnosis on Fridays waited longer for repair.
These results suggest variation in care patterns of rhegmatogenous retinal detachment by day of the week.
Because variation in care on weekends has been reported in many surgical fields, it is of interest if variations were noted for care patterns of rhegmatogenous retinal detachments (RRDs).
To assess the association between modality of RRD repair and day of the week that patients receive a diagnosis or undergo RRD repair.
Design, Setting, and Participants
A retrospective claims-based cohort analysis was performed of primary RRD surgery for 38 144 commercially insured patients in the United States who received a diagnosis of incident RRD between January 1, 2008, and December 31, 2016, and underwent repair within 14 days of diagnosis. Multinomial regression models were used to assess patients’ likelihood of repair with different modalities, logistic regression models were used to assess patients’ likelihood of reoperation, and linear regression models were used to assess time from diagnosis to repair. Data analysis was performed from March 9 to September 5, 2019.
Day of the week that the patient received a diagnosis of RRD or underwent RRD repair.
Main Outcome and Measures
Modality of repair, time from diagnosis to repair, and 30-day reoperation rate.
Among the 38 144 patients in the study (23 031 men [60.4%]; mean [SD] age at diagnosis, 56.8 [13.4] years), pneumatic retinopexy (PR) was more likely to occur when patients received a diagnosis of RRD on Friday (relative risk ratio [RRR], 1.37; 95% CI, 1.17-1.60), Saturday (RRR, 1.73; 95% CI, 1.36-2.20), or Sunday (RRR, 1.53; 95% CI, 1.08-2.17) compared with Wednesday. Pneumatic retinopexy was more likely to be used for surgical procedures on Friday (RRR, 1.55; 95% CI, 1.33-1.80), Saturday (RRR, 2.03; 95% CI, 1.61-2.56), Sunday (RRR, 2.28; 95% CI, 1.55-3.35), or Monday (RRR, 1.70; 95% CI, 1.46-1.98). Patients undergoing PR on Sundays were more likely to receive another procedure (PR, scleral buckle, or pars plana vitrectomy) within 30 days (odds ratio, 1.62; 95% CI, 1.07-2.45). An association between the need for reoperation for repairs performed via scleral buckle or pars plana vitrectomy and the day of the week of the initial repair was not identified. Patients who received a diagnosis on a Friday waited a mean of 0.28 days (95% CI, 0.20-0.36 days) longer for repair than patients who received a diagnosis on a Wednesday.
Conclusions and Relevance
These findings suggest that management of RRD varies according to the day of the week that diagnosis and repair occurs, with PR disproportionately likely to be used to repair RRDs during the weekend. Ophthalmologists should be aware that these results suggest that patients undergoing PR on Sundays may be more likely to require reoperation within 30 days.
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Vail D, Pan C, Pershing S, Mruthyunjaya P. Association of Rhegmatogenous Retinal Detachment and Outcomes With the Day of the Week That Patients Undergo a Repair or Receive a Diagnosis. JAMA Ophthalmol. Published online December 19, 2019. doi:10.1001/jamaophthalmol.2019.5253
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