Prevalence of systemic disease in patients undergoing cataract surgery at a hospital versus outpatient clinics.

Abstract

Objective: To compare demographic and clinical characteristics of patients undergoing cataract surgery at a hospital versus a private outpatient clinic (POC) within a shared funding model in Ontario, Canada. Our tertiary academic hospital operates a unique funding arrangement, in which some hospital funds support cataract surgeries at a POC, enabling oversight of provincially funded surgeries at both sites.

Design: Retrospective cohort study.

Participants: All patients who underwent cataract surgery in 2023 at both the hospital (Kingston Health Sciences Centre) and the affiliated POC were included.

Methods: We compared demographic and clinical data, including age, gender, blood pressure, comorbidities (e.g., diabetes, hypertension), American Society of Anesthesiologists scores, and medication usage.

Results: Patients included in this study numbered 3441 (1982 hospital patients and 1459 POC patients). Mean age was similar, although significantly more females underwent surgery at the POC (p = 0.004). Hospital patients had higher systolic blood pressure (p < 0.0001), higher rates of diabetes (1.5 odds ratio, 95% confidence interval [CI] 1.3-1.8; p < 0.0001), higher American Society of Anesthesiologist scores (0.3 mean difference, 95% CI 0.27-0.35; p < 0.0001), and higher smoking rates (p < 0.0001). The use of anticoagulation, antidiabetes, and prostate medications were significantly higher among hospital patients (p < 0.001), with greater use of antihypertensive medications (p = 0.018).

Conclusions: Our data support concerns that healthier patients are more likely to undergo surgery at outpatient clinics. Factors, such as mandated restrictions on patient selection at POCs, surgeon preference, and referral patterns may contribute. As outpatient surgical care grows, documenting these differences is essential to ensure fair distribution of resources and equitable access to care.