Ophthalmic Surgery, Lasers and Imaging Retina

Clinical Science 

Timing and Reoperation Rate of Rhegmatogenous Retinal Detachments Occurring During Major Ophthalmology Meetings

Daniel Vail, BA; Ahmad Al-Moujahed, MD, PhD, MPH; Natalia F. Callaway, MD, MS; Marco H. Ji, MD; Cassie A. Ludwig, MD, MS; Darius M. Moshfeghi, MD

Abstract

BACKGROUND AND OBJECTIVE:

To investigate whether surgical management of newly diagnosed rhegmatogenous retinal detachment (RRD) varies if patients are diagnosed during a major national ophthalmology conference.

PATIENTS AND METHODS:

This retrospective cohort study included 34,759 patients with incident RRD, of whom, 1,246 (3.6%) were diagnosed during dates of three national ophthalmology conferences, and 1,170 (3.4%) underwent surgery during conference dates. The authors identified patients with primary repair with cryotherapy, laser, scleral buckle, pneumatic retinopexy, or pars plana vitrectomy. Multinomial logistic regression models were used to determine patients' likelihood of receiving each type of repair within 30 days of their diagnosis depending on whether they were diagnosed during a national ophthalmology conference. Linear regression models were used to determine the relationship between the date patients were diagnosed and how long they waited to receive a repair. Main outcome measures included days between diagnosis with RRD and RRD repair, receiving repair on the same day of diagnosis, and reoperation rate within 30 days of the primary repair.

RESULTS:

Mean time from diagnosis to repair was 1.5 days (standard deviation: ± 2.4 days), and 71% of patients underwent repair within a day of diagnosis. Repairs were followed by a second surgery within 30 days in 11.1% of patients. Patients diagnosed during conferences waited 0.23 days longer between diagnosis and repair compared with patients diagnosed outside of conference dates (P = .001). Patients diagnosed with RRD during conferences were less likely to receive surgical repair within a day of diagnosis compared to patients diagnosed during non-conference dates (P = .037). Patients who were diagnosed with RRD during a conference date and also received surgery during a conference date were more likely to undergo a second surgery within 30 days of the primary procedure (P = .006)

CONCLUSIONS:

Patients diagnosed with RRD during national ophthalmology conference dates waited slightly longer for surgery, were slightly less likely to receive surgery within a day, and were more likely to undergo a second surgery within 30 days of the primary procedure. The “national meeting effect” phenomenon is present in ophthalmology, albeit to a lesser degree that is likely not visually significant.

[Ophthalmic Surg Lasers Imaging Retina. 2020;51:328–337.]

Abstract

BACKGROUND AND OBJECTIVE:

To investigate whether surgical management of newly diagnosed rhegmatogenous retinal detachment (RRD) varies if patients are diagnosed during a major national ophthalmology conference.

PATIENTS AND METHODS:

This retrospective cohort study included 34,759 patients with incident RRD, of whom, 1,246 (3.6%) were diagnosed during dates of three national ophthalmology conferences, and 1,170 (3.4%) underwent surgery during conference dates. The authors identified patients with primary repair with cryotherapy, laser, scleral buckle, pneumatic retinopexy, or pars plana vitrectomy. Multinomial logistic regression models were used to determine patients' likelihood of receiving each type of repair within 30 days of their diagnosis depending on whether they were diagnosed during a national ophthalmology conference. Linear regression models were used to determine the relationship between the date patients were diagnosed and how long they waited to receive a repair. Main outcome measures included days between diagnosis with RRD and RRD repair, receiving repair on the same day of diagnosis, and reoperation rate within 30 days of the primary repair.

RESULTS:

Mean time from diagnosis to repair was 1.5 days (standard deviation: ± 2.4 days), and 71% of patients underwent repair within a day of diagnosis. Repairs were followed by a second surgery within 30 days in 11.1% of patients. Patients diagnosed during conferences waited 0.23 days longer between diagnosis and repair compared with patients diagnosed outside of conference dates (P = .001). Patients diagnosed with RRD during conferences were less likely to receive surgical repair within a day of diagnosis compared to patients diagnosed during non-conference dates (P = .037). Patients who were diagnosed with RRD during a conference date and also received surgery during a conference date were more likely to undergo a second surgery within 30 days of the primary procedure (P = .006)

CONCLUSIONS:

Patients diagnosed with RRD during national ophthalmology conference dates waited slightly longer for surgery, were slightly less likely to receive surgery within a day, and were more likely to undergo a second surgery within 30 days of the primary procedure. The “national meeting effect” phenomenon is present in ophthalmology, albeit to a lesser degree that is likely not visually significant.

[Ophthalmic Surg Lasers Imaging Retina. 2020;51:328–337.]

Introduction

Each year, thousands of ophthalmologists attend national scientific meetings in the United States. In 2018, 15,233 domestic and international physicians and health professionals attended the annual meeting of the American Academy of Ophthalmology (AAO) and 3,435 physicians attended the retina subspecialty day during the same conference.1 In other medical specialties, patient outcomes in the setting of certain acute conditions have been correlated with receipt of care during national meeting dates. Some high-risk patients admitted to teaching hospitals with acute cardiovascular conditions during national cardiology meetings have been shown to have lower rates of mortality compared to similar patients admitted on non-conference days.2,3 Mortality is higher among patients admitted to some trauma centers during surgical conference dates.4 Similar studies in Japan have found no difference in mortality among trauma patients and cardiology patients admitted during conference dates for their respective specialties.5,6 To date, no study has investigated whether management of acute ophthalmic conditions is associated with receipt of care during national ophthalmology meetings.

Rhegmatogenous retinal detachment (RRD) is the most common vision-threatening ophthalmic emergency. RRDs require emergent evaluation and repair, as outcomes are improved with earlier treatment regardless of whether the macula is involved.7,8 The efflux of a large number of retina specialists to national meetings such as AAO, the Association for Vision Research in Ophthalmology (ARVO), and the American Society of Retina Specialists (ASRS) leaves some hospitals and clinics short-staffed, which could negatively affect the management RRDs.

This study aimed to investigate the extent to which variation in surgical management of newly diagnosed RRD is associated with whether patients are diagnosed during a major national ophthalmology conference. We estimate the association between diagnosis during an ophthalmology conference with wait times between diagnosis and surgical repair, odds of receiving repair on the day of diagnosis, and odds of the primary repair procedure requiring surgical reoperation within 30 days. We hypothesize that emergent repair of incident RRD is often delayed after diagnosis and that the odds of reoperation are higher among patients diagnosed with RRD during the highest attended national ophthalmology meetings.

Patients and Methods

Data Source and Sample Selection

Calendar dates for scientific sessions at three annual national ophthalmology conferences were obtained for each year from 2008 to 2016 for the annual meetings of the AAO, ARVO, and the ASRS. All conference dates are available in Table A.

National Ophthalmology Conference Dates Included in this Study

Table A:

National Ophthalmology Conference Dates Included in this Study

We selected patient records from the Truven MarketScan Commercial Claims and Encounters database, which comprises more than 56,000,000 unique commercially insured patients covered by more than 350 unique health carriers. This database has been used in previous health systems studies, including studies of the management of RRDs.9

We selected all patients with a new diagnosis of RRD who had not previously been diagnosed with any RRD. We limited our sample to patients who underwent repair of their RRD with pneumatic retinopexy (PR), scleral buckle (SB), or pars plana vitrectomy (PPV) within 14 days of diagnosis to ensure we were selecting patients with new RRDs. Diagnoses and procedures were identified using International Classification of Diseases 9th Edition diagnosis codes and Current Procedural Terminology (CPT) codes.

We further limited our sample to patients with continuous enrollment in the MarketScan database to ensure patients did not experience insurance coverage gaps during the study period that would result in their medical care being unobserved in the database. We required patients in our sample to have at least 365 days of continuous insurance coverage preceding their index diagnosis of RRD to avoid including patients with preexisting diagnoses of RRD, and required patients to have at least 30 days of continuous insurance coverage following surgical repair of their RRD, which allows us to calculate 30-day re-operation rates for all patients in our sample.

Outcome Measures

Variation in surgical management is captured by three outcome measures: days between diagnosis with RRD and RRD repair, whether patients receive repair on the same day as their diagnosis, and whether patients undergo a reoperation within 30 days of the primary repair. As a secondary analysis, we estimate whether patients who receive surgeries during conference dates are more likely to be repaired with a different surgical approach (either PR, SB, or PPV) than patients who receive repair on non-conference dates.

Variables

Our primary exposure variable is a binary variable indicating whether patients were diagnosed with RRD or received surgery for RRD during a major ophthalmology conference. Days from diagnosis to repair is a continuous variable, whereas same-day repair and 30-day revision are binary variables.

We created additional variables to account for temporal trends that may be associated with management of RRD and may confound the effect of diagnosis or surgical repair occurring during an ophthalmology conference. We use a categorical variable to indicate the year of patients' RRD diagnosis and repair, as previous studies have illustrated changes in management patterns of RRD over time.10 We also created a categorical variable indicating the day of the week of patients' diagnosis and repair, as a previous study has demonstrated an association between the management of newly diagnosed RRD and day of week.11

In addition, we created a binary variable indicating female sex, as previous analyses have shown associations between patient sex and likelihood and speed of receiving RRD repair.12,13 We also accounted for patient's age at diagnosis with RRD and for ocular comorbidities that may be associated with surgeons' decisions about what procedure to use to repair an RRD (namely myopia, pseudophakia, lattice degeneration, and vitreous hemorrhage). All ocular comorbidities were coded using a 365-day look-back window from the date of the index diagnosis of RRD. Finally, we include a categorical variable indicating the type of health insurance plan each patient has as this may be associated with patients' access to timely ophthalmic care. This variable is drawn directly from the MarketScan database and has not been recoded.

Statistical Analysis

We used multivariable linear regression models to estimate the association between diagnosis with RRD during a national ophthalmology conference and days to repair of the RRD (a continuous variable). For our binary outcome variables (RRD repair on the day of diagnosis and 30-day reoperation of primary RRD repair), we used multivariable logistic regression models to calculate the odds ratio of each outcome associated with diagnosis or surgery during an ophthalmology conference. We used three approaches to investigate the association between surgical revision and conference dates. First, we specified models that estimate the odds of 30-day surgical reoperation among all patients who undergo PR, SB, or PPV during a conference. We noted that some of the patients who receive surgery during a conference will be patients who were diagnosed with RRD before the conference and were scheduled to receive surgery during the conference. To investigate whether outcomes may be different among patients repaired emergently during conferences, we re-specified the same models, but restricted our exposure group to patients who were diagnosed with RRD during a conference and also received surgery during the conference. Finally, we estimated a set of models that restrict the sample to all patients who underwent surgical repair within a day of diagnosis of RRD, presumably capturing the most emergent detachments presenting during a conference, including macula-on and fovea-sparing detachments. As a sensitivity analysis, we specified a multinomial logistic model of the type of surgery patients received for their RRD to determine whether patients who underwent repair on conference dates were more likely to be repaired with a different procedure than other patients.

Results

Sample Characteristics

We identified 34,759 patients with a new diagnosis of RRD between 2008 and 2016 who met all inclusion and exclusion restrictions for this analysis. Among these patients, 1,246 (3.6%) were diagnosed during AAO, ARVO, or ASRS, and 1,170 (3.4%) underwent surgery during conference dates. Among the sample patients, 62.5% were men with mean age at diagnosis of 57 years old. Most patients (62.5%) were insured under a Preferred Provider Organization (PPO) health plan and received surgery in an outpatient hospital (63.6%), an outpatient office (19.5%), or an ambulatory surgical center (15.6%). The majority of patients were repaired with PPV (72.4%), followed by PR (15.7%), and SB (12.0%). The mean time from diagnosis to repair was 1.5 days (standard deviation [SD]: ± 2.4 days), and 71% of patients underwent repair within a day of diagnosis. Primary surgical repairs were followed by a second surgery within 30 days in 11.1% of patients. Between meeting and non-meeting dates, patients in the overall sample had similar demographic characteristics, surgery type, place of surgery, and health insurance plan (Table 1).

Characteristics of Patients With a New Diagnosis of Rhegmatoenous Retinal Detachment Between 2008 and 2016 During Dates of Three National Ophthalmology Conferences Characteristics of Patients With a New Diagnosis of Rhegmatoenous Retinal Detachment Between 2008 and 2016 During Dates of Three National Ophthalmology Conferences

Table 1:

Characteristics of Patients With a New Diagnosis of Rhegmatoenous Retinal Detachment Between 2008 and 2016 During Dates of Three National Ophthalmology Conferences

Time from Diagnosis to Repair of RRD During Conference Dates

In an unadjusted linear regression model, patients who were diagnosed with RRD during one of the aforementioned ophthalmology conferences waited, on average, 0.15 days (3.6 hours) longer between diagnosis and surgical repair than patients diagnosed outside of conference dates (P = .034). This difference persisted after accounting for the day of the week of diagnosis, year of diagnosis, and patient characteristics, with an adjusted linear regression model estimating that patients diagnosed during conferences wait 0.23 days (5.5 hours) longer for repair (P = .001). Patients diagnosed on Fridays waited 0.3 (7.2 hours) days longer for repair compared to patients diagnosed on Wednesdays (P < .001). Older patients received care slightly more quickly on average than younger patients, and patients with vitreous hemorrhage were operated on slightly faster, on average, than other patients (P < .001). Patients with “comprehensive” health plans waited approximately half a day longer on average for surgery than all other patients (Table 2). In comprehensive health plans, as defined by Truven MarketScan user guide, there is no incentive for the patient to use a particular list of providers and coverage is handled by only one policy, with a deductible and coinsurance.

Adjusted Modeling of Time to Repair of Incident RRD Occurring During National Ophthalmology Conference Dates

Table 2:

Adjusted Modeling of Time to Repair of Incident RRD Occurring During National Ophthalmology Conference Dates

Logistic regression models indicate that patients diagnosed with RRD during one of the studied ophthalmology conferences were less likely to receive surgical repair within a day of diagnosis compared to patients diagnosed during non-conference dates (odds ratio [OR] 0.87; P = .037) (Table 2).

Odds of Surgical Reoperation Within 30 Days of Primary Repair of RRD During Conference Dates

Unadjusted logistic regression models of revision of primary surgical repairs suggest a positive correlation between risk of surgical reoperation and receipt of surgery during a conference date (OR 1.21; P = .031), but this correlation is not statistically significant after accounting for other temporal factors and patient characteristics (OR 1.15; P = .125) (Table 3). However, patients who were diagnosed with RRD during a conference date and also received surgery during a conference date were more likely to undergo a second surgery within 30 days of the primary procedure, even in adjusted models (OR 1.33; P = .006) (Table 3). The estimated effect persisted in sensitivity models that restrict the sample to all patients who underwent surgery for their RRD within a day of diagnosis (OR 1.27; P = .024) (Table 3). Women appeared to be at lower risk of undergoing a second procedure within 30 days in all models of surgical revision, whereas myopes and patients with vitreous hemorrhage had higher odds of reoperation (Table 3). Patients who underwent surgery on certain days of the week (Saturday, Sunday, and Monday) appeared to be at higher risk for revision than patients who underwent surgery in the middle of the week. Differences in re-operation rates during national meetings do not appear to be driven by differences in the type of surgical approach used to repair patients' RRDs. Patients who underwent repair on conference dates are no more likely to receive PR or SB than other patients (Table B).

Adjusted Modeling of Likelihood of Reoperation Within 30 days of Repair of Incident RRD Occurring DuringNational Ophthalmology Conference Dates Adjusted Modeling of Likelihood of Reoperation Within 30 days of Repair of Incident RRD Occurring DuringNational Ophthalmology Conference Dates

Table 3:

Adjusted Modeling of Likelihood of Reoperation Within 30 days of Repair of Incident RRD Occurring DuringNational Ophthalmology Conference Dates

Multinomial Model of Type of Surgical Repair for RRD Occurring During National Ophthalmology Conference Dates (N = 33,717)

Table B:

Multinomial Model of Type of Surgical Repair for RRD Occurring During National Ophthalmology Conference Dates (N = 33,717)

Discussion

This is the first study to investigate the existence of a “national meeting effect” in ophthalmology. We find that patients who underwent emergent repair of incident RRDs during three major national ophthalmology conferences waited 0.23 days longer for repair, on average, than patients who received care on non-conference days, and had slightly lower odds of being repaired within a day of diagnosis (OR 0.87; 95% CI, 0.77–0.99; P = .03). These results are statistically significant, but are unlikely to be clinically significant, or to have negative long-term effects on patients' vision. Although modalities of repair were not significantly different during national meeting dates, patients who were diagnosed with RRD and received emergent repair during a conference had 33% higher odds of undergoing a second surgery within 30 days of their primary procedure (OR 1.33; 95% CI, 1.08–1.62).

No previous studies have investigated the “national meeting effect” phenomenon on management of ophthalmic emergencies. Prior studies have reported an “off-hours” effect and “weekend effect” in ophthalmology and other surgical fields that all comment on common obstacles during these times including fewer staff, logistical difficulties associated with anesthesia clearance and operation room booking, surgeon fatigue, scrub technicians with less ophthalmic experience, and less experienced surgeons (trainees) operating.2,4–6,14–20

The increased reoperation rate for incident RRDs diagnosed and repaired during ophthalmology meetings warrants further investigation, but is consistent with previously reported increased complication rates with emergent vs scheduled ophthalmic surgery14 and increased complication rates reported by other surgical specialties.17–19 Staffing shortfalls could be an important reason for the longer wait time between RRD diagnosis and surgery during conference dates. This includes fewer surgeons available, calling in operating room teams and nurses from home with associated commute delay, difficulty obtaining anesthesia clearance, and longer wait times for limited operating room availability. It is also possible that only some institutions have decreased staffing during conference dates, which leads to consolidating patients to high-performance and sufficiently staffed eye centers. This consolidation may result in delay in performing surgeries due to the referral process and the large number of cases in these centers. The possibility that relatively less experienced retina specialists remain in hospitals during meeting dates could explain the higher odds of surgical revision within 30 days of primary repair of RRD, however, prior literature on outcomes and complication rates between cases performed with and without a vitreoretinal surgical fellow found no difference in outcomes.21 This could also be explained by older retina specialists, but with diminished skill set, remaining in hospitals during meeting dates. Surgeon fatigue may impact performance and play an important role during conference coverage at high-volume referral centers, but this has not been studied in ophthalmology.

Although some academicians are questioning the usefulness of medical conferences,22 these conferences are still a dominant feature of the academic, professional, and social life of all physicians, including ophthalmologists. The newly identified “national meeting effect” phenomenon should prompt organizers of these conferences to consider providing additional opportunities for remote conferencing and social networking tools so that all ophthalmology centers can maintain their capacity, while still enabling ophthalmologists to benefit from the educational and social opportunities the conferences offer.4,22

In addition to being the first of its kind in ophthalmology, the main strength of this study is the use of a national database that provides access to data of a large number of unique patients in a broad geographic region.

The primary weakness of this study is that which is inherent to claims based analyses: the inability to elucidate the specific causes of increased wait time between RRD diagnosis and surgery, the decreased likelihood to receive surgery within a day, or the higher odds of 30-day surgical revision for RRD cases diagnosed and repaired during national ophthalmology conferences. In addition, our study did not evaluate the long-term anatomic and functional outcomes of these patients, so we are not able to assess if this slight delay in treatment had any negative consequences on patients' visual acuity. Further studies are needed to investigate these aspects.

In summary, patients diagnosed with RRD during dates of national ophthalmology conferences wait 0.23 days longer for surgery, are slightly less likely to receive surgery within a day, and are more likely to undergo a second surgery within 30 days of the primary procedure compared to patients diagnosed with RRD outside the dates of conferences. Our findings indicate that the “national meeting effect” phenomenon is present in ophthalmology, albeit to a lesser degree that is likely not visually significant, and that hospitals and ophthalmic departments should be aware of the unique circumstances surrounding ophthalmic care during national conferences. In addition, organizers of national ophthalmology conferences should consider providing additional opportunities to enable ophthalmologists to benefit from these conferences remotely while still providing optimal patient care.

References

  1. Meeting Attendance: Annual Meeting Attendance Figures. American Academy of Ophthalmology website. www.aao.org/annual-meeting/meeting-attendance. Accessed May 19, 2019.
  2. Jena AB, Prasad V, Goldman DP, Romley J. Mortality and treatment patterns among patients hospitalized with acute cardiovascular conditions during dates of national cardiology meetings. JAMA Intern Med. 2015;175(2):237–244. doi:10.1001/jamainternmed.2014.6781 [CrossRef] PMID:25531231
  3. Jena AB, Olenski A, Blumenthal DM, Yeh RW, Goldman DP, Romley J. Acute Myocardial Infarction Mortality During Dates of National Interventional Cardiology Meetings. J Am Heart Assoc. 2018;7(6):e008230. doi:10.1161/JAHA.117.008230 [CrossRef] PMID:29523525
  4. Jenkins PC, Painter S, Bell TM, Kline JA, Zarzaur BL. The conference effect: national surgery meetings are associated with increased mortality at trauma centers without American College of Surgeons verification. PLoS One. 2019;14(3):e0214020. doi:10.1371/journal.pone.0214020 [CrossRef] PMID:30913224
  5. Mizuno S, Kunisawa S, Sasaki N, Fushimi K, Imanaka Y. In-hospital mortality and treatment patterns in acute myocardial infarction patients admitted during national cardiology meeting dates. Int J Cardiol. 2016;220:929–936. doi:10.1016/j.ijcard.2016.06.168 [CrossRef] PMID:27420345
  6. Yumoto T, Naito H, Ihoriya H, Yorifuji T, Nakao A. Mortality in trauma patients admitted during, before, and after national academic emergency medicine and trauma surgery meeting dates in Japan. PLoS One. 2019;14(1):e0207049. doi:10.1371/journal.pone.0207049 [CrossRef] PMID:30695039
  7. Greven MA, Leng T, Silva RA, et al. Reductions in final visual acuity occur even within the first 3 days after a macula-off retinal detachment. Br J Ophthalmol. 2019;103(10):1503–1506. doi:10.1136/bjophthalmol-2018-313191 [CrossRef] PMID:30504489
  8. van Bussel EM, van der Valk R, Bijlsma WR, La Heij EC. Impact of duration of macula-off retinal detachment on visual outcome: a systematic review and meta-analysis of literature. Retina. 2014;34(10):1917–1925. doi:10.1097/IAE.0000000000000296 [CrossRef] PMID:25121930
  9. Vaziri K, Schwartz SG, Kishor KS, et al. Rates of Reoperation and Retinal Detachment after Macular Hole Surgery. Ophthalmology. 2016;123(1):26–31. doi:10.1016/j.ophtha.2015.09.015 [CrossRef] PMID:26505804
  10. Nemet A, Moshiri A, Yiu G, Loewenstein A, Moisseiev E. A Review of Innovations in Rhegmatogenous Retinal Detachment Surgical Techniques. J Ophthalmol. 2017;2017:4310643. doi:10.1155/2017/4310643 [CrossRef] PMID:28584664
  11. Vail D, Pan C, Pershing S, Mruthyunjaya P. Association of Rhegmatogenous Retinal Detachment and Outcomes With the Day of the Week That Patients Undergo a Repair or Receive a Diagnosis. JAMA Ophthalmol. 2019Dec19. doi:10.1001/jamaophthalmol.2019.5253 [CrossRef]. [Epub ahead of print] PMID:31855233
  12. Vail D, Pershing S, Reeves MG, Afshar AR. The Relative Impact of Patient, Physician, and Geographic Factors on Variation in Primary Rhegmatogenous Retinal Detachment Management. Ophthalmology. 2020;127(1):97–106. doi:10.1016/j.ophtha.2019.04.019 [CrossRef] PMID:30981916
  13. Natalia FC, Vail D, Pershing S, et al. Gender Differences in Surgical Intervention Rate and Timing for Rhegmatogenous Retinal Detachments Among US Commercially Insured Patients From 20072015. Invest Ophthalmol Vis Sci. 2019;60(9):65–88.
  14. Hartz AJ, Burton TC, Gottlieb MS, et al. Outcome and cost analysis of scheduled versus emergency scleral buckling surgery. Ophthalmology. 1992;99(9):1358–1363. doi:10.1016/S0161-6420(92)31794-4 [CrossRef] PMID:1407969
  15. Frimpong-Ansah K, Kirkby GR. Arrangements for the management of urgent retinal detachments in the United Kingdom and Eire in the year 2000: results of a survey. Eye (Lond). 2002;16(6):754–760. doi:10.1038/sj.eye.6700326 [CrossRef] PMID:12439672
  16. Rojas J, Fernández I, Pastor JC, Gómez-Ulla F, Piñero A. [Urgent retinal detachment management by the National Health System of Spain. Project Retina 2]. Arch Soc Esp Oftalmol. 2007;82(5):279–284. PMID:17516264
  17. Goldstein SD, Papandria DJ, Aboagye J, et al. The “weekend effect” in pediatric surgery - increased mortality for children undergoing urgent surgery during the weekend. J Pediatr Surg. 2014;49(7):1087–1091. doi:10.1016/j.jpedsurg.2014.01.001 [CrossRef] PMID:24952794
  18. Zapf MAC, Kothari AN, Markossian T, et al. The “weekend effect” in urgent general operative procedures. Surgery. 2015;158(2):508–514. doi:10.1016/j.surg.2015.02.024 [CrossRef] PMID:26013983
  19. Desai V, Gonda D, Ryan SL, et al. The effect of weekend and after-hours surgery on morbidity and mortality rates in pediatric neurosurgery patients. J Neurosurg Pediatr. 2015;16(6):726–731. doi:10.3171/2015.6.PEDS15184 [CrossRef] PMID:26406160
  20. Tadisina KK, Chopra K, Singh DP. The “weekend effect” in plastic surgery: analyzing weekday versus weekend admissions in body contouring procedures from 2000 to 2010. Aesthet Surg J. 2015;35(8):995–998. doi:10.1093/asj/sjv088 [CrossRef] PMID:26019238
  21. Mason JO IV, Mason LB, Patel SA, et al. VITREORETINAL SURGICAL OUTCOMES PERFORMED BY SUPERVISED RETINAL FELLOWS VERSUS ATTENDING FACULTY SURGEONS. Retina. 2016;36(5):981–985. doi:10.1097/IAE.0000000000000828 [CrossRef] PMID:26465616
  22. Ioannidis JPA. Are medical conferences useful? And for whom?JAMA. 2012;307(12):1257–1258. doi:10.1001/jama.2012.360 [CrossRef] PMID:22453564

Characteristics of Patients With a New Diagnosis of Rhegmatoenous Retinal Detachment Between 2008 and 2016 During Dates of Three National Ophthalmology Conferences

Characteristics All Patients (n = 34,759) Conference Dates Non-Conference Dates P Value

Diagnosis During Conference [n, (%)] 1,246 (100)
  AAO 300 (24.08)
  ARVO 545 (43.73)
  ASRS 401 (32.18)

Repair During Conference [n, (%)] 1,170
  AAO 249 (21.28)
  ARVO 535 (45.73)
  ASRS 386 (32.99)

Age (Years) [mean (SD)] 57.2 (13.4) 57.0 (13.5) 57.2 (13.4) .605

Gender [n, (%)]
  Male 21,737 (62.54) 715 (61.11) 21,022 (62.59) .306
  Female 13,022 (37.46) 455 (38.89) 12,567 (37.41)

Surgery Type [n, (%)]
  Pars plana vitrectomy 25,149 (72.35) 842 (71.97) 24,307 (72.37) .86
  Pneumatic retinopexy 5,450 (15.68) 182 (15.56) 5,268 (15.68)
  Scleral buckle 4,160 (11.97) 146 (12.48) 4,014 (11.95)

Place of Surgery [n, (%)]
  Outpatient hospital 22,105 (63.60) 751 (64.19) 21,354 (63.57) .937
  Office 6,765 (19.46) 233 (19.91) 6,532 (19.45)
  Ambulatory Surgery Center 5.429 (15.62) 173 (14.79) 5,256 (15.65)
  Inpatient hospital 188 (0.54) 6 (0.51) 182 (0.54)
  Emergency room 120 (0.35) 3 (0.26) 117 (0.35)
  Other 152 (0.44) 4 (0.34) 148 (0.44)

Year of Diagnosis [n, (%)]
  2008 3,038 (8.74) 105 (8.97) 2,933 (8.73) < .001
  2009 4,006 (11.53) 133 (11.37) 3,873 (11.53)
  2010 4,032 (11.60) 120 (10.26) 3,912 (11.65)
  2011 4,459 (12.83) 144 (12.31) 4,315 (12.85)
  2012 4,889 (14.07) 175 (14.96) 4,714 (14.03)
  2013 4,159 (11.97) 148 (12.65) 4,011 (11.94)
  2014 3,906 (11.24) 121 (10.34) 3,785 (11.27)
  2015 2,992 (8.61) 70 (5.90) 2,922 (8.70)
  2016 3,278 (9.43) 154 (13.16) 3,124 (9.30)

Insurance Plan [n, (%)]
  Comprehensive 3,257 (9.66) 102 (9.02) 3,155 (9.68) .708
  EPO 528 (1.57) 10 (1.59) 510 (1.57)
  HMO 3,283 (9.74) 127 (11.23) 3,156 (9.69)
  POS 2,199 (6.52) 66 (5.84) 2,133 (6.55)
  PPO 21,085 (62.54) 704 (62.25) 20,301 (62.55)
  POS with capitation 200 (0.59) 5 (0.44) 195 (0.60)
  CDHP 1,889 (5.60) 66 (5.84) 1,823 (5.59)
  HDHP 1,276 (3.78) 43 (3.80) 1,233 (3.78)

Days from Diagnosis to Repair [mean (SD)] 1.54 (2.44) 1.70 (2.51) 1.53 (2.45) .021

Repaired within a Day of Diagnosis [n, (%)] 24,827 (71.43) 800 (68.38) 24,027 (71.53) .019

Reoperation within 30 days of Surgery [n, (%)] 3,868 (11.13) 153 (13.08) 3,715 (11.06) .031

Adjusted Modeling of Time to Repair of Incident RRD Occurring During National Ophthalmology Conference Dates

Days Between Diagnosis and Repair 1 Odds of Same Day Repair 2
Variables * Adjusted Coefficient (95% CI) P Value * Adjusted OR (95% CI) P Value
Age (10-Year Increments) 0.23 (0.09–0.37) .001 0.87 (0.77–0.99) .037
− 0.04 (− 0.06 to −0.02) < .001 1.00 (1.00–1.00) .230
Gender
  Male 1.00 1.00
  Female 0.02 (−0.03–0.07) .456 0.99 (0.94–1.04) .596
Day of Diagnosis
  Wednesday 1.00 1.001
  Sunday −0.46 (−0.66 to −0.25) < .001 1.07 (0.87–1.31) .513
  Monday −0.06 (−0.14 to 0.03) .174 0.73 (0.68–0.79) < .001
  Tuesday −0.15 (−0.23 to 0.06) .001 0.86 (0.79–0.93) < .001
  Thursday 0.06 (−0.03 to 0.14) .203 1.07 (0.98–1.16) .137
  Friday 0.31 (0.22 to 0.40) < .001 0.56 (0.52–0.61) < .001
  Saturday −0.19 (−0.34 to −0.05) .008 0.56 (0.50–0.64) < .001
Year of Diagnosis
  2008 1.00 1.00
  2009 0.01 (−0.10 to 0.13) .802 0.94 (0.85–1.05) .287
  2010 −0.02 (−014 to 0.10) .731 0.97 (0.87−1.08) .546
  2011 −0.05 (−0.17 to 0.06) .384 0.96 (0.87–1.07) .495
  2012 −0.03 (−0.15 to 0.08) .554 0.95 (0.86–1.07) .339
  2013 0.00 (−0.11 to 0.12) .945 0.92 (0.83–1.03) .136
  2014 −0.04 (−0.16 to 0.08) .481 0.93 (0.83–1.03) .161
  2015 0.06 (−0.07 to 0.18) .384 0.86 (0.77–0.97) .013
  2016 0.44 (0.32 to 0.57) < .001 0.62 (0.55–0.69) < .001
Ocular Comorbidities
  Myopia 0.08 (−0.12 to 0.29) .419 0.89 (0.74–1.07) .210
  Pseudophakia 0.29 (0.03 to 0.55) .031 0.75 (0.60–0.94) .011
  Lattice degeneration 0.01 (−0.07 to 0.10) .740 0.96 (0.89–1.04) .348
  Vitreous hemorrhage −0.16 (−0.26 to −0.06) .001 1.27 (1.16–1.40) < .001
Insurance Plan
Comprehensive 1.00 1.00
EPO −0.44 (−0.66 to −0.21) < .001 1.41 (1.14–1.73) .001
HMO −0.41 (−0.54 to −0.29) < .001 1.44 (1.29−1.61) < .001
POS −0.41 (−0.55 to −0.27) < .001 1.36 (1.20–1.53) < .001
PPO −0.38 (−0.48 to −0.29) < .001 1.38 (1.27–1.50) < .001
POS with capitation −0.54 (−0.89 to −0.18) .003 1.53 (1.11–2.12) .010
CDHP −0.53 (−0.68 to −0.39) < .001 1.52 (1.33–1.73) < .001
HDHP −0.49 (−0.66 to −0.33) < .001 1.62 (1.39–1.88) < .001

Adjusted Modeling of Likelihood of Reoperation Within 30 days of Repair of Incident RRD Occurring DuringNational Ophthalmology Conference Dates

Sensitivity Analysis for Odds of Reoperation
Odds of Reoperation 1 Among All Patients 2 Among Same Day Repair 3
Variables * Adjusted OR (95% CI) P Value * Adjusted OR (95% CI) P Value * Adjusted OR (95% CI) P Value
Age (10-Year Increments) 1.15 (0.96–1.38) .125 1.33 (1.08–1.62) .006 1.27 (1.03–1.57) .024
1.00 (0.99–1.00) .001 1.00 (0.99–1.00) .001 1.00 (0.99–1.00) .007
Gender
  Male 1.00 1.00 1.00
  Female 0.91 (0.85–0.98) .013 0.91 (0.85–0.98) .013 0.88 (0.81–0.95) .002
Day of Diagnosis
  Wednesday 1.00 1.00 1.00
  Sunday 1.49 (1.14–1.94) .004 1.48 (1.13–1.94) .004 1.52 (1.15–2.00) .003
  Monday 1.20 (1.07–1.35) .002 1.20 (1.07–1.35) .001 1.28 (1.12–1.46) < .001
  Tuesday 1.01 (0.90–1.12) .897 1.01 (0.90–1.12) .913 0.99 (0.88–1.12) .916
  Thursday 0.92 (0.83–1.03) .140 0.92 (0.83–1.03) .144 0.94 (0.83–1.07) .362
  Friday 1.08 (0.97–1.21) .173 1.09 (0.97–1.22) .157 1.07 (0.94–1.22) .298
  Saturday 1.22 (1.02–1.44) .026 1.22 (1.03–1.45) .024 1.18 (0.98–1.42) .073
Year of Diagnosis
  2008 1.00 1.00 1.00
  2009 1.00 (0.86–1.16) .981 1.00 (0.86–1.16) .986 0.93 (0.79–1.11) .428
  2010 0.92 (0.79–1.07) .272 0.92 (0.79–1.07) .271 0.91 (0.77–1.08) .292
  2011 0.95 (0.82–1.09) .447 0.95 (0.82–1.09) .447 0.91 (0.77–1.07) .245
  2012 0.91 (0.79–1.05) .217 0.91 (0.79–1.05) .215 0.93 (0.79–1.09) .374
  2013 0.88 (0.76–1.02) .089 0.88 (0.76–1.02) .088 0.92 (0.78–1.09) .327
  2014 0.89 (0.76–1.03) .116 0.89 (0.76–1.03) .115 0.88 (0.74–1.04) .135
  2015 0.79 (0.67–0.94) .006 0.79 (0.67–0.94) .006 0.81 (0.67–0.98) .031
  2016 0.80 (0.67–0.94) .007 0.80 (0.67–0.94) .007 0.88 (0.73–1.07) .198
Ocular Comorbidities
Myopia 1.32 (1.04–1.67) .023 1.32 (1.04–1.68) .022 1.39 (1.06–1.83) .018
Pseudophakia 1.08 (0.76–1.53) .669 1.08 (0.76–1.54) .655 0.93 (0.59–1.46) .751
Lattice degeneration 1.03 (0.92–1.15) .637 1.03 (0.92–1.15) .630 1.02 (0.90–1.16) .781
Vitreous hemorrhage 1.15 (1.01–1.30) .033 1.15 (1.01–1.30) .033 1.20 (1.04–1.37) .010
Insurance plan
Comprehensive 1.00 1.00
EPO 1.03 (0.77–1.37) .846 1.03 (0.77–1.37) .853 0.87 (0.62–1.23) .245
HMO 0.96 (0.81–1.12) .585 0.95 (0.81–1.12) .578 0.95 (0.78–1.14) .562
POS 0.87 (0.73–1.05) .143 0.87 (0.73–1.05) .143 0.84 (0.68–1.04) .107
PPO 0.97 (0.85–1.10) .623 0.97 (0.85–1.10) .617 0.94 (0.81–1.09) .385
POS with capitation 1.31 (0.86–1.99) .203 1.31 (0.86–1.97) .207 1.34 (0.85–2.14) .210
CDHP 0.95 (0.78–1.15) .605 0.95 (0.78–1.15) .599 0.91 (0.73–1.14) .428
HDHP 0.92 (0.74–1.14) .443 0.92 (0.74–1.14) .434 0.89 (0.70–1.15) .378

National Ophthalmology Conference Dates Included in this Study

Conference Location Year Dates
ASRS Boston 2017 Aug 11–15, 2017
San Francisco 2016 Aug 9–14, 2016
Vienna, Austria 2015 July 11–14, 2015
San Diego 2014 Aug 9–13, 2014
Toronto 2013 Aug 24–28, 2013
Las Vegas 2012 Aug 25–29,2012
Boston 2011 August 20–24, 2011
Vancouver 2010 Aug 28–31, 2010
New York 2009 Sep 30–Oct 4, 2009
Hawaii 2008 Oct 11–15, 2008
Palm Spring 2007 Dec 1–5, 2007
Cannes, France 2006 Sep 9–13, 2006

AAO New Orleans 2017 Nov 11–14, 2017
Chicago 2016 Oct 15–18, 2016
Las Vegas 2015 Nov 14–17, 2015
Chicago 2014 Oct 18–21, 2014
New Orleans 2013 Nov 16–19, 2013
Chicago 2012 Nov 10–13, 2012
Orlando 2011 Oct 22–25, 2011
Chicago 2010 Oct 16–19, 2010
San Francisco 2009 Oct 24–27, 2009
Atanta 2008 Nov 8–11, 2008
New Orleans 2007 Nov 10–13, 2007
Las Vegas 2006 Nov 11–14, 2006

ARVO Baltimore 2017 May 7–11, 2017
Seattle 2016 May 1–5, 2016
Denver 2015 May 3–7, 2015
Orlando 2014 May 4–8, 2014
Seattle 2013 May 5–9, 2013
Fort Lauderdale 2012 May 6–10, 2012
Fort Lauderdale 2011 May 1–5, 2011
Fort Lauderdale 2010 May 2–6, 2010
Fort Lauderdale 2009 May 3–7, 2009
Fort Lauderdale 2008 Apr 27–May 1, 2008
Fort Lauderdale 2007 May 6–10, 2007
Fort Lauderdale 2006 Apr 30–May 4, 2006

Multinomial Model of Type of Surgical Repair for RRD Occurring During National Ophthalmology Conference Dates (N = 33,717)

Pneumatic Retinopathy* Scleral Buckle*

Variables * RRR (95% CI) P Value * RRR (95% CI) P Value

Age (10-Year Increments) 0.01 (−0.16–0.18) .905 0.04 (−0.15–0.23) .702
0 (0–0.01) .068 −0.04 (−0.05 to −0.04) < .001

Gender
  Male 1.00 1.00
  Female 0.05 (−0.02–0.11) .139 0.15 (0.08–0.22) < .001

Day of Diagnosis
  Wednesday 1.00 1.00
  Sunday 0.95 (0.72–1.17) < .001 0 (−0.33–0.33) .994
  Monday 0.48 (0.38–0.59) < .001 −0.02 (−0.14–0.1) .732
  Tuesday 0.14 (0.04–0.24) .008 0.06 (−0.05–0.17) .283
  Thursday 0 (−0.1–0.1) .962 −0.02 (−0.12–0.09) .770
  Friday 0.5 (0.4–0.6) < .001 0.12 (0.01–0.24) .039
  Saturday 0.71 (0.57–0.86) < .001 0.43 (0.27–0.6) < .001

Year of Diagnosis
  2008 1.00 1.00
  2009 0.01 (−0.12–0.13) .932 −0.03 (−0.17–0.11) .646
  2010 −0.02 (−0.15–0.11) .756 −0.2 (−0.34 to −0.06) .005
  2011 −0.16 (−0.29 to −0.03) .013 −0.32 (−0.47 to −0.18) < .001
  2012 −0.16 (−0.28 to −0.03) .014 −0.47 (−0.62 to −0.33) < .001
  2013 −0.28 (−0.41 to −0.15) < .001 −0.54 (−0.69 to −0.39) < .001
  2014 −0.3 (−0.43 to −0.16) < .001 −0.6 (−0.75 to −0.45) < .001
  2015 −0.42 (−0.56 to −0.27) < .001 −0.72 (−0.89 to −0.55) < .001
  2016 −0.46 (−0.61 to −0.31) < .001 −0.85 (−1.02 to −0.68) < .001

Ocular Comorbidities
  Myopia 0.23 (−0.01–0.46) .056 0.23 (0–0.46) .053
  Pseudophakia −0.35 (−0.7–0) .049 −1.52 (−2.34 to −0.71) < .001
  Lattice Degeneration −.23 (−0.34 to −0.12) < .001 0.33 (0.23–0.43) < .001
  Vitreous Hemorrhage −0.61 (−0.74 to −0.47) < .001 −1.44 (−1.66 to −1.23) < .001

Insurance Plan
  Comprehensive 1.00 1.00
  EPO 0.32 (0.06–0.58) .015 −0.27 (−0.57–0.04) .087
  HMO 0.27 (0.13–0.42) < .001 −0.11 (−0.29–0.06) .200
  POS 0.13 (−0.04–0.29) .128 −0.3 (−0.49 to −0.1) .003
  PPO 0.19 (0.08–0.31) .001 −0.23 (−0.37 to −0.08) .002
  POS with capitation 0.5 (0.11–0.88) .011 −0.02 (−0.46–0.43) .940
  CDHP 0.35 (0.18–0.52) < .001 −0.01 (−0.21–0.19) .927
  HDHP 0.49 (0.31–0.68) < .001 −0.14 (−0.36–0.09) .226
Authors

From Byers Eye Institute, Horngren Family Vitreoretinal Center, Stanford University School of Medicine Department of Ophthalmology, Palo Alto, California.

Supported by Research to Prevent Blindness, the National Eye Institute P30-EY026877, the Heed Ophthalmic Foundation and Ronald G. Michels Fellowship Foundation.

Dr. Moshfeghi reports the following disclosures: Pykus (equity, SAB), which is developing an agent for use after retinal detachment surgery; 1-800-Contacts (Board of Directors, equity); Akebia (ROP consulting); Alcon (Data Safety Monitoring Board); Allegro (SAB); Apellis (Site PI); Bayer (ROP Imaging Committee for FireFleye Trial); CME Outfitters (CME consultant); Congruence Medical Solutions (Consultant); dSentz (Founder, Board of Directors, equity); Iconic Therapeutics (Steering Committee); Irenix(SAB); Grand Legend Technology (Equity); Linc (Founder, Equity, Board of Directors); Novartis (Data Safety Monitoring Board, Pediatric Advisory Board); Pr3vent (Founder, Board of Directors, equity); Prime (CME consultant); Promisight (Founder, Board of Directors, equity); Pykus (SAB, equity); Regeneron (CME consultant, ROP Steering Committee for ButterFleye Trial); Retina Technologies LLC (Advisor); Shapiro Law (ROP expert witness); SUNDROP (Founder and Director, payment for services); Versl (Founder, equity); Vindico (CME consultant); Visunex Medical Systems, Co. Ltd (SAB, equity); Versl (Pediatric Retina Second Opinion, founder, equity); and Visunex Medical Systems LLC (camera manufacturer, equity, consultant). The remaining authors report no relevant financial disclosures.

Dr. Moshfeghi did not participate in the editorial review of this manuscript.

Address correspondence to Darius M. Moshfeghi, MD, Professor and Chief of Retina Division, Byers Eye Institute, Department of Ophthalmology Stanford University School of Medicine, 2452 Watson Court, Suite 2200, Palo Alto, CA 94305; email: dariusm@stanford.edu.

Received: March 31, 2020
Accepted: May 08, 2020

10.3928/23258160-20200603-03

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