Zusammenfassung
Die Katarakt-Chirurgie ist der häufigste elektive Eingriff bei älteren PatientInnen. In vielen europäischen Ländern sowie in den USA findet die Katarakt-Operation üblicherweise als tagesklinischer Eingriff statt, im Gegensatz zu Österreich mit derzeit knapp 2%. Bisher gibt es kaum prospektive Studien zu den Bedürfnissen und der Akzeptanz der PatientInnen bezüglich eines tagesklinischen Verfahrens. Ziel dieser Studie war es, die Nachfrage und Eignung der PatientInnen für eine tagesklinische Katarakt-Operation anhand einer präoperativen ophthalmologischen Untersuchung und eines Fragebogens betreffend die familiäre und soziale Unterstützung an 500 konsekutiven Katarakt-PatientInnen zu erheben. 154 (41,8%) der PatientInnen entschieden sich für einen tagesklinischen, 256 (58,2%) für einen stationären Aufenthalt. PatientInnen, die stationär behandelt werden wollten waren älter (76,4 ± 8,1 vs. 72,73 ± 9,5 Jahre, p < 0,001) und hatten ein schlechteres Sehvermögen (0,55 ± 0,20 vs. 0,66 ± 0,23, p < 0.001). Sie waren häufiger weiblich (63,9% vs. 47,0%, p = 0,001), lebten öfter mehr als eine Stunde vom Spital entfernt (26,5% vs. 12,5%, p < 0,001) und hatten seltener eine häusliche Versorgung (43,0% vs. 6,5%, p < 0,001). PatientInnen, die einen tagesklinischen Eingriff bevorzugten, hatten häufiger die Möglichkeit zu einer Kontrolluntersuchung 24 Stunden postoperativ (96,7% vs. 59,6%, p < 0,001). Die meisten PatientInnen zeigten eine Präferenz für einen stationären Aufenthalt. Dies kann aber auch auf einer Reflexion ihrer bisherigen Erfahrungen beruhen und der Gewohnheit der älteren Bevölkerung entsprechen. Information, Aufklärung und Hilfe bei der Organisation einer postoperativen Betreuung könnte die Attraktivität einer tagesklinischen Katarakt-Operation in Österreich erhöhen. Weiters könnten unsere Ergebnisse zur prinzipiellen Verbesserung der tagesklinischen Versorgung beitragen.
Summary
Cataract surgery is the most common elective surgical procedure undertaken in elderly people. In many European countries and in the USA cataract surgery is normally a day-case procedure without an overnight stay in hospital, unlike the situation in Austria where fewer than 2% of patients are day cases. However, there is a lack of prospective studies on patients' need for and acceptance of day-case surgery. The aim of our study was therefore to evaluate patients' demand and suitability for outpatient surgery, based on analysis of preoperative questionnaires on availability of family and/or social support and on preoperative ophthalmologic examination. Among 500 consecutive patients with cataract, 154 (41.8%) chose a day-case procedure and 256 (58.2%) preferred inpatient admission. Patients preferring full admission were older (mean age 76.4 ± 8.1 vs. 72.73 ± 9.5 years, P < 0.001), had worse visual acuity (0.55 ± 0.20 vs. 0.66 ± 0.23, P < 0.001), were more likely to be female (63.9% vs. 47.0%, P = 0.001), to live more than one hour away from the hospital (26.5% vs. 12.5%, P < 0.001) and have no carer at home (43.0% vs. 6.5%, P < 0.001). Patients favoring day-case surgery were more likely to be able to attend an ophthalmologic check-up 24 h after surgery (96.7% vs. 59.6%, p < 0.001). The majority of patients indicated a preference for inpatient care, but this may be a reflection of their previous hospital experience and a matter of custom in the elderly population. Information, education and better organization of after-surgery services could help increase the attractiveness of cataract surgery as an outpatient procedure in Austria. Our findings could also be relevant to day-case services in medical care in general.
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Weingessel, B., Richter-Mueksch, S., Weingessel, A. et al. Is day-case cataract surgery an attractive alternative from the patients' point of view? A questionnaire survey. Wien Klin Wochenschr 120, 756–760 (2008). https://doi.org/10.1007/s00508-008-1113-3
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DOI: https://doi.org/10.1007/s00508-008-1113-3