Unplanned Return to the Operating Room After Cataract Surgery

PURPOSE: To determine the rate of unplanned return to the operating room (OR) within 90 days of cataract surgery and to identify the most common preoperative and intraoperative risk factors. DESIGN: Retrospective case-control study. SUBJECTS AND CONTROLS: Patients aged ≥40 years undergoing cataract surgery at the Wilmer Eye Institute between 2019 and 2022 with at least 90 days of postoperative follow-up were included. Patients with return to the OR for a reason other than a postoperative complication of cataract surgery in the same eye were excluded. For each case, a time-matched control (cataract surgery within 1 month of the case's surgery) was selected using a random number generator. METHODS: The chi-squared test was used for categorical variables, the student's t-test for continuous variables, and the multivariable logistic regression analysis to assess for associated preoperative and intraoperative factors. MAIN OUTCOME MEASURES: The main outcomes included the rate and the most common reasons for unplanned return to the OR as well as the odds ratios of associated preoperative and intraoperative variables. RESULTS: Among 32,480 eyes, 175 eyes (0.54%) had an unplanned return to the OR within 21 ± 21 days of cataract surgery. The most common reason was retained lens fragments in 88 eyes (50%). Patients with an unplanned return to the OR had a worse mean best-corrected visual acuity preoperatively (Snellen equivalent of ∼20/100 for cases vs 20/50 for controls, p-value < .001) and at last follow-up (cases 20/50, controls 20/30, p-value < .001). There were significantly higher odds of an unplanned return to the OR for patients undergoing complex cataract surgery (odds ratio, 1.80; 95% CI, 1.06-3.05) and for patients with prior tamsulosin use (odds ratio, 2.00; 95% CI, 1.09-3.69). CONCLUSIONS: Patients undergoing complex cataract surgery and those with prior tamsulosin use had significantly higher odds of unplanned return to the OR. Monitoring rates of unplanned return to the OR at the institutional and national levels by using national clinical registries or a multicenter study is needed to assist in quality monitoring and to improve patient surgical outcomes.