[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
[Skip to Content Landing]
Views 3,552
Citations 0
Original Investigation
December 19, 2019

Association of Rhegmatogenous Retinal Detachment and Outcomes With the Day of the Week That Patients Undergo a Repair or Receive a Diagnosis

Author Affiliations
  • 1Byers Eye Institute, Department of Ophthalmology, Stanford University, Stanford, California
  • 2Veterans Affairs Palo Alto Health Care System, Palo Alto, California
JAMA Ophthalmol. Published online December 19, 2019. doi:10.1001/jamaophthalmol.2019.5253
Key Points

Question  What is the association of management of rhegmatogenous retinal detachment with the day of the week?

Findings  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.

Meaning  These results suggest variation in care patterns of rhegmatogenous retinal detachment by day of the week.


Importance  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).

Objective  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.

Exposures  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.

Results  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.

Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words