Change for the better? Where the future of surgery may be going

(Image credit: AdobeStock/Kadmy)

For obvious reasons, I prefer not to mention the dates of my ophthalmology residency (hint: it wasn’t yesterday). My residents today probably think I am pulling their legs when I tell them that my little ophthalmology department in Baltimore, Maryland, had 120 inpatient beds, and those beds were kept full during my first year. Patients were admitted the night before their cataract surgery and stayed through the day of surgery. On day 3, the patch and shield were removed, and assuming everything looked good, the patient was discharged.

In my second year of residency, I was in the operating room with the chair emeritus of the department. This was a famous man, and we were performing cataract surgery on one of his patients. I asked him about a rumor that cataract surgery patients might no longer be allowed to stay in the hospital. The former chair dismissed the idea. “If they don’t stay in the hospital, the patients will go home, get up in the night to go to the bathroom, fall down, and rupture their cataract wounds and go blind,” he said. “Never will I agree to perform outpatient cataract surgery!”

You know what happened. Six months after that conversation, cataract surgery became an outpatient procedure, and many of the inpatient areas were converted for other uses.I believe we can agree today that the outcomes with outpatient cataract surgery are excellent, and patients are probably better off being in their usual home environment rather than in a strange hospital room.

What can we learn from this besides the fact that—dare I say it—ophthalmology department chairs are not always right? To me, the lesson is that major changes in health care delivery can occur, even over the strong objections of many eminent physicians, as long as the outcomes are measured and shown to be equivalent or better than the prior care.

So, I find the article in this issue by Omar R. Shakir, MD, MBA, extolling the virtues of office-based vitrectomy surgery thought-provoking, and I hope you will read it and consider his rationale. I appreciate the attention to the patients’ perspective (although I’m not sure he wants to give coffee and pastries to preoperative patients). What I, being a “numbers guy,” don’t see in the article is a measurement of outcomes. Does performing vitrectomy in the office result in the same or better postoperative results than in a more traditional hospital outpatient operating room or ambulatory surgery center? If the data prove the answer to be yes, I am open to new models and venues of care.