Cataracts: How do day surgery and overnight hospital stays compare?

Patients who return straight home after cataract surgery have as good outcomes as those who stay overnight in hospital. But a direct comparison between clinics is not possible without publication of individual practice outcomes.

The lens in an eye gets cloudy and blurry in more than 1 out of every 10 people over the age of 40. This condition is called a cataract. It reduces the clarity of vision, and in particular it gets difficult to see small things properly. At first glasses can help. But when the lens gets too cloudy, an operation to remove it is the only way to get good sight back.

Cataract operations are one of the most common surgical procedures in countries like Germany. Usually the lens can be removed through a very small cut in the cornea of the eye. The lens will then be broken up and sucked out. This process is called phacoemulsification. The function of the lens is then replaced by an artificial lens or glasses.

This procedure is done under local anaesthetic. Patients in Germany and similar countries usually have the choice of a stay in hospital or having day surgery. After day surgery, the person can return home within a few hours of the operation.

To find out whether this early discharge increases the risk of poor outcomes after the surgery, researchers from the Cochrane Collaboration analysed trials of day surgery for cataracts. They found two trials that included around 1,300 people. The smaller of the two trials was finished more than 20 years ago, so the researchers relied mostly on the results of the second trial. This was done in Spain a few years ago, with about 950 patients.

The result: four months after the procedure people had the same clarity of vision whether they had day surgery or were admitted to hospital. Short-term complications were somewhat more common in the day surgery patients, but this had no impact on the ultimate success of the procedure.

This assessment is based on the results of one study, so it is possible that outcomes might vary between other clinics. In Germany, a direct comparison between clinics is not possible, because the results of surgery are not routinely publicly available.

© IQWiG (Institute for Quality and Efficiency in Health Care)