International Ophthalmology

, Volume 39, Issue 4, pp 873–881 | Cite as

Determinants of inappropriate hospitalization in cataract surgery in the south of Italy: a retrospective study

  • Salvatore CillinoEmail author
  • Aissa Iggui
  • Simona Di Naro
  • Giovanni Cillino
  • Domenica Matranga
  • Walter Mazzucco
  • Fanny Pojero
  • Alessandra Casuccio
Original Paper



To analyze the frequency of inappropriate hospitalization in cataract surgery and the type of related determinants.


A nested retrospective case–control study was carried out on 2708 consecutive cataract surgery patients operated between January 2013 and December 2015. All cases with inappropriate hospitalization (day surgery or ordinary hospitalization) were compared with a control group of cases treated in an appropriate (day service) regimen. The predictive value for inappropriate admissions to the hospital was assessed using a logistic regression model. Significant variables from the univariate analysis were included in a multivariate model.


Forty-five cases (< 2%) of inappropriate hospital admissions were recorded. Residence, heart disease, tremors, anticoagulants, intraoperative floppy iris syndrome were not related to appropriateness, while psychotic disorder (OR 12.571, p = 0.018), anxiety-depressive syndrome (OR 7.818, p = 0.010) and use of antipsychotropic drugs (OR 7.724, p = 0.002) were related to the inappropriateness of admission by univariate and multivariate analysis. Previous systemic surgeries were predictors of ordinary hospitalization by logistic regression analysis. A greater presence of hypertension, diabetes mellitus and fellow eye pseudophakia was noticed in appropriate hospitalization cases.


This study detects the predictive role of psychiatric disorders as determinants of hospitalization inappropriateness in cataract surgery. The negative correlation between inappropriate hospitalization and conditions such as hypertension and diabetes points out that in the elderly population common diseases are effectively addressed, in contrast to the difficult management of psychiatric patients. Prior systemic interventions represent factors inducing transfer from day service to ordinary hospitalization, highlighting communication problems related to difficult coping with an outpatient surgery setting.


Surgical appropriateness Hospitalization appropriateness Cataract surgery Comorbidities and hospital appropriateness 


Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest.


  1. 1.
    Franco G (2004) Health policy and occupational health: tools and methods to assure quality and appropriateness of interventions. Med Lav 95:3–10Google Scholar
  2. 2.
    The Royal College of Surgeons of England (1992) Guidelines for day case surgery. London: RCSENG - Professional Standards and RegulationGoogle Scholar
  3. 3.
    Legislative Decree 229/99. Accessed 20 February 2017
  4. 4.
    Woodcock M, Shah S, Smith RJ (2004) Recent advances in customising cataract surgery. BMJ 328:92–96CrossRefGoogle Scholar
  5. 5.
    Crabtree HL, Hildreth AJ, O’Connell JE et al (1999) Measuring visual symptoms in British cataract patients: the cataract symptom scale. Br J Ophthalmol 83:519–523CrossRefGoogle Scholar
  6. 6.
    Fedorowicz Z, Lawrence D, Gutierrez P (2005) Day care versus in-patient surgery for age-related cataract. Cochrane Database Syst Rev 1:CD004242Google Scholar
  7. 7.
    Fedorowicz Z, Lawrence D, Gutierrez P et al (2011) Day care versus in-patient surgery for age-related cataract. Cochrane Database Syst Rev 7:CD004242Google Scholar
  8. 8.
    Lawrence D, Fedorowicz Z, van Zuuren EJ (2015) Day care versus in-patient surgery for age-related cataract. Cochrane Database Syst Rev 11:CD004242Google Scholar
  9. 9.
    Atalla ML, Wells KK, Peucker N et al (2000) Cataract extraction in a major ophthalmic hospital: day-case or overnight stay? Clin Experiment Ophthalmol 28:83–88CrossRefGoogle Scholar
  10. 10.
    Cooper JM (1996) Development of day-case cataract surgery: a literature review. Br J Nurs 5:1327–1333CrossRefGoogle Scholar
  11. 11.
    Cooper JM (1997) Day-case cataract surgery in the UK and USA: a comparative study. Br J Nurs 6:39–43CrossRefGoogle Scholar
  12. 12.
    McCarty CA (2002) Cataract in the 21st Century: lessons from previous epidemiological research. Clin Exp Optom 85:91–96CrossRefGoogle Scholar
  13. 13.
    Richter-Mueksch S, Zehetmayer M, Radner W et al (2001) Influence of sex, visual acuity, and systemic disease on delayed presentation for cataract surgery in Austria. J Cataract Refract Surg 27:1999–2005CrossRefGoogle Scholar
  14. 14.
    Wong TY (2001) Effect of increasing age on cataract surgery outcomes in very elderly patients. BMJ 322:1104–1106CrossRefGoogle Scholar
  15. 15.
    Conner-Spady BL, Sanmugasunderam S, Courtright P et al (2005) Patient and physician perspectives of maximum acceptable waiting times for cataract surgery. Can J Ophthalmol 40:439–447CrossRefGoogle Scholar
  16. 16.
    Lundstrom M, Albrecht S, Nilsson M et al (2006) Benefit to patients of bilateral same-day cataract extraction: randomized clinical study. J Cataract Refract Surg 32:826–830CrossRefGoogle Scholar
  17. 17.
    Mavrikakis I, Georgiou T, Paul B et al (2006) Cataract surgery by appointment—a pilot study. BMC Ophthalmol 6:18CrossRefGoogle Scholar
  18. 18.
    Mojon-Azzi SM, Mojon DS (2007) The rate of outpatient cataract surgery in ten European countries: an analysis using data from the SHARE survey. Graefes Arch Clin Exp Ophthalmol 245:1041–1044CrossRefGoogle Scholar
  19. 19.
    Barbieri V, Schmid E, Ulmer H et al (2007) Health care supply for cataract in Austrian public and private hospitals. Eur J Ophthalmol 17:557–564CrossRefGoogle Scholar
  20. 20.
    Weingessel B, Richter-Mueksch S, Weingessel A et al (2008) Is day-case cataract surgery an attractive alternative from the patients’ point of view? A questionnaire survey. Wien Klin Wochenschr 120:756–760CrossRefGoogle Scholar
  21. 21.
    Pact Health of 3/12/2009. Accessed 20 February 2017
  22. 22.
    Cillino S, Casuccio A, Di Pace F et al (2007) Day care cataract surgery in Central and Southern Italy: a multicentric survey. BMC Health Serv Res 7:16CrossRefGoogle Scholar
  23. 23.
    Italian Ophthalmological Society (Società Oftalmologica Italiana - SOI) - Clinical and Organizational Guidelines on Surgery Of Cataract –SOI edition, November 2014. Accessed 20 February 2017
  24. 24.
    Lavis JN, Anderson GM (1996) Appropriateness in health care delivery: definitions, measurement and policy implications. CMAJ 154:321–328Google Scholar
  25. 25.
    Appleby J, Raleigh V, Frosini F, Bevan G, Gao H, Lyscom T (2011) Variations in health care. The King’s Fund. Website: Last accessed 25 October 2016
  26. 26.
    Noest S, Ludt S, Klingenberg A, Glassen K, Heiss F, Ose D, Rochon J, Bozorgmehr K, Wensing M, Szecsenyi J (2014) Involving patients in detecting quality gaps in a fragmented healthcare system: development of a questionnaire for Patients’ Experiences Across Health Care Sectors (PEACS). Int J Qual Health Care 26:240–249CrossRefGoogle Scholar
  27. 27.
    Southern DA, Hall M, White DE, Romano PS, Sundararajan V, Droesler SE, Pincus HA, Ghali WA (2016) Opportunities and challenges for quality and safety applications in ICD-11: an international survey of users of coded health data. Int J Qual Health Care 28:129–135CrossRefGoogle Scholar
  28. 28.
    Rumball-Smith J, Sarfati D, Hider P, Blakely T (2013) Ethnic disparities in the quality of hospital care in New Zealand, as measured by 30-day rate of unplanned readmission/death. Int J Qual Health Care 25:248–254CrossRefGoogle Scholar
  29. 29.
    Moraros J, Lemstra M, Nwankwo C (2016) Lean interventions in healthcare: do they actually work? A systematic literature review. Int J Qual Health Care 28:150–165CrossRefGoogle Scholar
  30. 30.
    Suarez C, Tolou C, Cassagne M et al (2013) Quels obstacles au développement de la chirurgie ambulatoire de la cataracte au CHU de Toulouse en 2013? J Fr d’Ophtalmol 38:822–831CrossRefGoogle Scholar
  31. 31.
    International Association for Ambulatory Surgery (2001) Council of Presidents Foundation and early history of the international association for ambulatory surgery 1995–2001. Ambul Surg 9:125–126. CrossRefGoogle Scholar
  32. 32.
    De Lathouwer C, Poullier JP (2000) How much ambulatory surgery in the World in 1996–1997 and trends? Ambul Surg 8:191–210. CrossRefGoogle Scholar
  33. 33.
    Castells X, Alonso J, Castilla M et al (2001) Outcomes and costs of outpatient and inpatient cataract surgery: a randomised clinical trial. J Clin Epidemiol 54:23–29. CrossRefGoogle Scholar
  34. 34.
    Guzzanti E, Mastrobuono I (1999) Organisational, technological and structural standards for office based ambulatory surgery and day surgery. Ambul Surg 7:159–165. CrossRefGoogle Scholar
  35. 35.
    Kroneman MW, Westert GP, Groenewegen PP et al (2001) International variations in the availability and diffusion of alternatives to in-patient care in Europe: the case of day surgery. Ambul Surg 9:147–154. CrossRefGoogle Scholar
  36. 36.
    Nghiem-Buffet MH, de Pouvourville G, Renard G et al (2001) Cost of managing cataracts. Evaluation of traditional hospitalization and ambulatory surgery. Presse Med 30:1924–1926Google Scholar
  37. 37.
    Ogg T (1998) Office-based surgery: How should the International Association for ambulatory surgery proceed? Ambul Surg 6:187–188. CrossRefGoogle Scholar
  38. 38.
    Finance Act 2006-Law n. 266, 23/12/2005, Rules for drawing up of the annual and multiannual budget of the State. Accessed 20 February 2017
  39. 39.
    Health Ministry (2011) Appropriateness Project - Research and experimentation of indicators to determine the degree of appropriateness of the services of hospitalization caused by deficiencies of other forms of assistance. Accessed 20 February 2017
  40. 40.
  41. 41.
    Bailey FW (1928) Cataract operations performed on patients in their own beds. J Iowa Med Soc 18:8–10Google Scholar
  42. 42.
    Ingram RM, Banerjee D, Traynar MJ et al (1983) Day-case cataract surgery. Br J Ophthalmol 67:278–281CrossRefGoogle Scholar
  43. 43.
    Decree President Council of Ministers 29 November 2001. Definition of the Essential Levels of Assistance. Ministry of Health Hospital discharge appropriateness in Italy with APPRO methodology Roma 2002Google Scholar

Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology SectionUniversity of PalermoPalermoItaly
  2. 2.Department of Sciences for Health Promotion and Mother-Child Care “G. D’Alessandro”University of PalermoPalermoItaly

Personalised recommendations