| Background: China is the most populous country in the world and cataract is the leading cause of blindness in China,but high incidence and low operation rate are still severe public health problems."Difficult to see a doctor,high cost,difficulty for a bed and surgery" are the most prominent medical problems.Day care surgery is considered as a medical mode with high efficiency and low cost all over the world,and it can alleviate the medical shortage and reduce the financial burden of patients effectively.Cataract surgery is very suitable for day care surgery because of its own characteristics.In recent years,day care surgery has developed rapidly in China,but there are still big gaps between China and developed countries,such as Europe and the United States,and one of the main obstacles is reimbursement.In this study,a retrospective study was conducted to evaluate the clinical efficacy and safety of day care cataract surgery,and evaluated the advantages of it and the influence of medical insurance on it compared with inpatient surgery,and then,discussed the reasons for restricting day care surgery in China,so as to provide references for promoting the development of day care surgery in China.Part 1Purpose: To evaluate the safety,quality and prospects of cataract day care surgery performed in a Jiangsu public tertiary hospitalMethods: The general data and clinical data for patients with cataract day care surgery between August 1,2014 and December 31,2016 at this hospital were collected,and the incidences of intra-operative and post-operative complications,pre-operative and post-operative best corrected visual acuitie(BCVA),delayed discharge rate,rate of unplanned re-admission to hospital,and patient satisfaction were analyzed.Results: Totally 4151 patients underwent a cataract phacoemulsification surgery for correcting cataracts with categories of age-related,congenital,traumatic,and complicated ones,and age-related cataracts were the most frequent types.Patients ranged in age from 18 to 101 years,with the majority of patients being between 60 and 80 years old.Of the 4151 patients,64.73% had one or more systemic diseases.The number of patients was increasing every year,with the average number of patients every month of 90.4,124.83,and 183.42 respectively from 2014 to 2016.The average pre-operative BCVA was 0.102±0.057 and average post-operative BCVAs at 1 day,1week,and 1month post surgery were respectively 0.453±0.264,0.657±0.285,and 0.734±0.244.For intra-operative complications,4.12% of the patients had posterior capsule rupture(PCR),0.79% of the patients had iris injury or ciliary body injury,and 0.048% of the patients had suprachoroidal hemorrhage.For postoperative complications,4.38% of the patients suffered cornea edema,7.78% of the patients suffered intraocular hypertension,0.096% of the patients suffered anterior segment toxicity syndrome(TASS),0.28% of the patients suffered retained lens cortex,and 0.048% of the patients suffered hyphema.The delayed discharge rate was 0.82% and the unplanned readmission to the hospital was 0%.The patient satisfaction rate was 91.42%.Conclusions: Cataract day care surgery is effective and safe,and the prospects for development are bright.Part 2 Purpose: To evaluate the advantages and problems of cataract day care surgery compared with common inpatient surgery,and to put forward some guiding Suggestions for the improvement of medical policyMethods: General information of patients who received cataract surgeries respectively in the cataract day ward and ordinary ward of the hospital from August 1,2014 to December 31,2016 was collected.The age,sex,hospitalization days,costs,payment methods and the sources of the two groups of patients were analyzed,and the differences between day care surgery and inpatients surgery were compared.Results: There were no significant differences in age and gender between the two groups(P > 0.05).In terms of hospitalization time,there was only one day in the day care ward,and the average hospitalization days in the general ward were 4.40±1.69 days,with statistically significant difference(P < 0.001).The total costs of day care surgery(mean 6893.68±1362.89￥)was significantly lower than those of inpatients surgery(mean 7849.70±1432.70￥),and the difference was statistically significant(P < 0.001).In terms of the payment method,more patients with day care surgery paid for the surgery by Urban Employees Basic Medical Insurance(UEBMI),while most of the inpatients tended to pay by Out-of-Pocket Medical Treatment(OMT),with the difference of statistical significance(P < 0.001).Local patients were the majority in the day ward,and the difference was statistically significant(P < 0.001).Conclusions: The hospitalization time was shorter and the costs were lower with cataract day care surgery compared with common inpatients surgery.The medical insurance policy for day care surgery should be improved and supported by government policiesDay care cataract surgery is more economical than inpatient surgery.The medical insurance policy for day care surgery should be improved and it should be further promoted and supported by government policies. |
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