title: Diabetic retinopathy and complexity of retinal surgery in a general hospital.
abstract: BACKGROUND
  Usual retinal surgery (vitrectomy or surgery for retinal detachment) may require additional procedures to deal with complex cases, which increase time and resource use and delay access to treatment. We undertook this study to identify the proportion of primary retinal surgeries that required complex procedures and the associated causes.
  
  
  METHODS
  We carried out an observational, descriptive, cross-sectional, retrospective study. Patients with primary retinal surgery were evaluated (January 2007-December 2010). The proportion and 95% confidence intervals (CI) of preoperative diagnosis and cause of the disease requiring retinal surgery as well as the causes for complex retinal surgery were identified. Complex retinal surgery was defined as that requiring lens extraction, intraocular lens implantation, heavy perfluorocarbon liquids, silicone oil tamponade or intravitreal drugs, in addition to the usual surgical retinal procedure. The proportion of complex retinal surgeries was compared among preoperative diagnoses and among causes (χ(2), odds ratio [OR]).
  
  
  RESULTS
  We studied 338 eyes. Mean age of subjects was 53.7 years, and there were 49% females. The most common diagnoses were vitreous hemorrhage (27.2%) and rhegmatogenous retinal detachment (24.6%). The most common cause was diabetes (50.6%); 273 eyes required complex surgery (80.8%, 95% CI: 76.6-85). The proportion did not differ among diagnoses but was higher in diabetic retinopathy (89%, p <0.001, OR 3.04, 95% CI: 1.63-5.7).
  
  
  CONCLUSIONS
  Of the total sample, 80.8% of eyes required complex surgical procedures; diabetic retinopathy increased by 3-fold the probability of requiring these complex procedures. Early treatment of diabetic retinopathy may reduce the proportion of complex retinal surgery by 56%.
authors.affiliation: Servicio de Oftalmología, Hospital Juárez de México, México, DF, Mexico.
authors.forename: Laura Fanny
authors.initials: LF
authors.lastname: Mijangos-Medina
authors.forename: Blanca Esmeralda
authors.initials: BE
authors.lastname: Hurtado-Noriega
authors.forename: Virgilio
authors.initials: V
authors.lastname: Lima-Gómez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002387:Cataract Extraction / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000601:surgery*; D042241:Early Diagnosis; D005260:Female; D006769:Hospitals, General; D006801:Humans; D056965:Injections, Intraocular / Q000706:statistics & numerical data; D019654:Lens Implantation, Intraocular / Q000706:statistics & numerical data; D007906:Lens Subluxation / Q000601:surgery; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures / Q000706:statistics & numerical data*; D012163:Retinal Detachment / Q000601:surgery; D012164:Retinal Diseases / Q000601:surgery*; D012189:Retrospective Studies; D014821:Vitrectomy / Q000706:statistics & numerical data; D014823:Vitreous Hemorrhage / Q000601:surgery; D055815:Young Adult