[Efficacy and cost of ambulatory cataract surgery: a systemic review].
BACKGROUND
A systematic review has been performed on the literature in order to assess efficacy and costs of cataract ambulatory surgery. The objective of the review were the randomized controlled trials comparing benefits, adverse effects and costs of ambulatory and inpatient cataract surgery, including, in addition, an original trial of our investigation group.


METHODS
The sources of information have been: MEDLINE (between 1985 and 1998), HealthStar (1975-98), Evidence-Based, the systematic review of the journals of ophthalmology (1992-98) and the review of the references in the documents or articles reviewed. The quality of the trials was assessed according to criteria proposed by the Evidence-Based Medicine Working Group. Data extracted from each study included: design, object population, setting, type of intervention and treatment, and follow-up period. Outcomes of ambulatory surgery were compared to those of inpatient surgery concerning to benefits (postoperative visual acuity), adverse effects (surgical complications) and costs of the surgery.


RESULTS
From 44 studies satisfying inclusion criteria, only 5 randomized controlled trials and 10 observational studies had the necessary information to be included in the review. In all the studies postoperative visual acuity was similar between the two groups (inpatients and outpatients). In the quantitative synthesis of the trials included in the review, outpatients presented a higher rate of perioperatory (48 hours after surgery) complications (OR = 1.4; IC 95%: 1.1-1.8) and of increase of intraocular pressure (OR = 2.3; IC 95%: 1.3-3.9). The ambulatory surgery costs were from a 15 to a 30% lower, depending on the study analyzed.


CONCLUSIONS
Ambulatory cataract surgery patients present a benefit in visual acuity similar to inpatients. However, the higher risk of surgical complications among outpatients suggests the appropriateness of improving their immediate postoperative care. Even though some variability exists in the method to calculate costs, the results suggest that ambulatory surgery is the most efficient alternative.
Castells
X
X
Unidad de Investigación, Institut Municipal d'Investigació Mèdica (IMIM), Barcelona. 87184@imas.imim.es
Alonso
J
J
Castilla
M
M
Comas
M
M
D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000191:economics*; D002387:Cataract Extraction / Q000191:economics*; D003362:Cost-Benefit Analysis; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D016896:Treatment Outcome; D014792:Visual Acuity