National audit of the outcome of primary surgery for rhegmatogenous retinal detachment. II. Clinical outcomes.
OBJECTIVE
This national study was designed to audit anatomical outcome and complications relating to primary surgery for rhegmatogenous retinal detachments. This paper presents success and complication rates, and examines variations in outcome.


METHODS
Sampling and recruitment details of this nationwide cross-sectional survey of 768 patients of 167 consultant ophthalmologists having their first operation for rhegmatogenous retinal detachment have been described. The main clinical outcomes detailed here are anatomical reattachment at 3 months after surgery and complications related to surgery. Consultants with a declared special interest in retinal surgery and able to perform pars plana vitrectomy were designated specialists for the analyses.


RESULTS
Overall reattachment rate with a single procedure was 77% (95% CI 73.9-80.2). There were significant differences in reattachment rates between specialists and non-specialists. Without allowing for case-mix, specialists had a reattachment rate of 82% (95% CI 77.9-85.7) with a single procedure and non-specialists 71% (95% CI 65.9-76.0). Allowing for case-mix, there was a significant difference between specialists and non-specialists for grade 2 detachments of 87% and 70% respectively (P < 0.0001). Analysing detachments by break type, the largest difference between specialists and non-specialists was observed for retinal detachments secondary to horseshoe tears, 80% and 68% respectively (P < 0.003). Specialists met the standards set for primary reattachment rates, while non-specialists did not. Over a third of patients had at least one complication reported at some point during the audit period.


CONCLUSIONS
Significant differences were seen in reattachment rates between specialists and non-specialists, overall and for specific subgroups of patients. This study provides relevant, robust and valid standards to enable all surgeons to audit their own surgical outcomes for primary retinal detachment repair in rhegmatogenous retinal detachments, identify common categories of failure and aim to improve results.
Thompson
J A
JA
Royal College of Ophthalmologists, London, UK. julietthompson@doctors.net.uk
Snead
M P
MP
Billington
B M
BM
Barrie
T
T
Thompson
J R
JR
Sparrow
J M
JM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D005500:Follow-Up Studies; D019538:Health Care Surveys; D006801:Humans; D008485:Medical Audit; D008505:Medical Staff, Hospital / Q000592:standards; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications; D015203:Reproducibility of Results; D012163:Retinal Detachment / Q000601:surgery*; D012720:Severity of Illness Index; D013038:Specialization; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D006113:United Kingdom