Evaluating ASC-4 transfer rates in cataract surgery: insights into timing and causes of hospital transfers.

PURPOSE: To describe the causes, timing, and contributing factors of direct hospital transfer cases from an ophthalmology-specific ambulatory surgery center (ASC) and to identify potential strategies for decreasing future transfers.

SETTING

A large ophthalmology surgery center in Des Moines, Iowa.

DESIGN

Retrospective review.

METHODS

A retrospective chart review was performed on patients requiring hospital transfer from a Midwest ophthalmology-specific surgery center from March 2022 through July 2024. Variables reviewed included patient demographics, comorbidities, prior surgeries/surgical complications, results of preoperative physical examinations, type of surgery and anesthesia performed, the type and timing of each complication, and the reasons for transfer. Each transfer was assessed for its necessity, preventability, and outcome.

RESULTS

22 patients required hospital transfer of 24 960 admissions for a rate of 0.88 per 1000 admissions (95% CI, 0.58-1.33). Only 5 (23%) transfer cases were temporally related to anesthesia or surgery. The other 17 (77%) had concerns first noted before the induction of anesthesia. 9 (41%) of the surgeries were completed, 1 (5%) partially completed, and the remaining 12 (55%) surgeries were cancelled. The reasons for transfer were largely cardiac-related and/or blood pressure-related (18/22, 82%). Nearly a third of the transfers (7/22, 32%) were considered preventable.

CONCLUSIONS

Hospital transfers from ASCs are rare, and all-cause hospital transfer rates may overestimate the true risk of ocular surgery. Most patients requiring hospital transfer were identified in the preoperative area. Greater attention to preoperative physical examination reports could potentially prevent some hospital transfers.