Outpatient cataract surgery overtaking inpatient care throughout Europe

OPHTHALMOLOGISTS in at least five European nations now perform the vast majority of their cataract surgery on an outpatient basis, new statistics show.
The statistics, from the Organisation for Economic Cooperation and Development (OECD), found that ophthalmologists in Denmark, Finland, the Netherlands, Norway, and the United Kingdom perform more than 80% of cataract surgery on outpatients.

The statistics, which are the first of their kind by the OECD, confirm the ever-increasing role of outpatient services in cataract surgery. The OECD statistics also document what ophthalmologists already know from experience - that outpatient cataract surgery has been growing steadily over the last decade.
In Finland for instance, ophthalmologists performed 0.3% of cataract surgery on an outpatient basis in 1991. Ever since then, however, the percentage of outpatient cataract surgery has risen. In 2001, ophthalmologists in Finland performed 86.9% of their cataract surgery on outpatients.

United Kingdom-based ophthalmologists likewise showed a marked increase in the percentage of cataract operations performed on outpatients over the decade. In 2001, British ophthalmologists performed 83.5% of the country's cataract surgery on an outpatient basis; in 1991, they performed just 5.6% of cataract surgery on outpatients.

In Denmark, ophthalmologists performed 95.7% of their cataract surgery on outpatients in 2001. That figure compares to 79.7% of cataract surgery as recently as 1996.
In the Netherlands, ophthalmologists performed 88.9% of cataract operations on outpatients in 2001, up from 71.6% only two years before.
And, according to the most recent data from Norway, ophthalmologists there performed 87.3% of cataract operations on outpatients in 2000.

The statistics compare favourably to other non-European countries with high rates of outpatient cataract surgery. For example, ophthalmologists in Australia performed 84.1% of their cataract surgery on outpatients as recently as 2000; New Zealand colleagues performed an even higher percentage of cataract surgery on outpatients - 89.6%.

The OECD figures, however, show that ophthalmologists in a number of European countries - France, Ireland, Italy, Luxembourg and Portugal - continue to perform a majority of their cataract surgery as inpatient procedures. In 2000, ophthalmologists in France performed 31.8% of cataract operations on outpatients; in 2001, outpatients accounted for 33.7% of cataract operations in Ireland, 47.1% of cataract operations in Italy, 28% of cataract operations in Luxembourg, and 30.9% of cataract operations in Portugal.
Even in those five European countries, however, the statistics indicate that outpatient services could soon predominate, given that the percentage of outpatient cataract surgery is generally increasing.

In Portugal, for instance, the percentage of cataract surgery performed on an outpatient basis more than tripled in just one year, from 9.1% in 2000 to the 30.9% figure recorded in 2001.
In Ireland, the percentage of cataract surgery performed on outpatients more than tripled between 1995 and 2001. By 2001, in Italy, the percentage of cataract surgery performed on outpatients had increased by eight-fold over the 1996 figures. Only in Luxembourg has the rate of outpatient cataract surgery remained relatively constant over the past few years, varying between 27.8% and 29.3%.

Annual rate of cataract surgery increasing The rate of cataract surgery continues to increase throughout Europe and the rest of the developed world, according to the OECD. Their latest figures show that ophthalmologists are performing more than 700 cataract operations per 100,000 of population in four European countries Those figures, from Hungary, France, Italy and Luxembourg, show marked increases from the rate recorded as recently as five or six years ago. In France, for instance, ophthalmologists performed 726.2 cataract operations per 100,000 persons in 2000; in 1993, the rate was 430.3 per 100,000 of population. In Italy, ophthalmologists performed 735.2 cataract operations per 100,000 of population in 2001; by contrast, they performed 356.7 such operations in 1996. In Hungary, the rate of cataract surgery was 723.6 per 100,000 of population in 2001; in Luxembourg, the rate was 730.4 cataract operations per 100,000 of population. Virtually every European and non-European country included in the OECD figures has recorded a steady increase in the rate of cataract surgery over the last decade, in parallel with their ageing populations. For instance, in Portugal, ophthalmologists performed cataract surgery at a rate of 195.8 operations per 100,000 of population in 2001; that figure represents a two-and-a-half-fold increase over the 1993 rate of 83.1 operations per 100,000 of population. In Ireland, ophthalmologists performed 354.2 cataract operations per 100,000 of population in 1995; by 2001 they performed 480.2 operations per 100,000 of population. Even in Mexico's underfunded health service, ophthalmologists have been able to increase the rate of cataract surgery - to 43.9 in 2001 from 26.1 in 1995. Despite the overall increase in the rate of cataract surgery, some countries have experienced dips in the rate of cataract surgery, due largely to government policy, state and insurance funding, and the past success in reducing waiting lists. In Finland, for instance, ophthalmologists performed 582.9 cataract operations per 100,000 of population in 2001, down from a high of 650 operations per 100,000 of population in 1999. In Australia, ophthalmologists operated on 712.3 cataracts for every 100,000 persons, down from the high of 896.5 cataract operations per 100,000 of population in 1998. By contrast, in the United Kingdom, ophthalmologists continue to perform more cataract operations each year in a bid to reduce waiting lists. In 2001, for instance, British ophthalmologists removed 469.3 cataracts for every 100,000 of population, up 15% from 2000 alone and more than two and a half times the rate of cataract surgery performed in 1991. Average length of stay decreasing for admitted cataract patients The average length of stay for patients admitted to the hospital for cataract surgery is dropping in parallel with the rise in the rate of outpatient cataract surgery, the OECD has found. Throughout Europe and the rest of the developed world, the average length of stay for cataract surgery plummeted to 2.5 days in 2001 from 12.5 days in 1976, according to the OECD figures. Individual European nations have shown similarly huge drops in the average length of stay. Whereas Finish inpatients stayed an average of 11.9 days in the hospital for a cataract operation performed in 1976, they now stay only 1.1 days - if they are admitted as inpatients at all. Danish inpatients who would have stayed in hospital for an average of 5.3 days for cataract surgery in 1986 stayed an average of 1.5 days in 2001. Italian inpatients who would have stayed in hospital for an average of 11 days in 1986 stayed an average of 2.1 days in 2001. Within Europe, the longest lengths of stay are reported from countries in Central and Eastern Europe. For instance, in 2001, the Czech Republic recorded an average length of stay of 3.4 days, the Slovak Republic an average length of stay of 4.9 days, Hungary an average length of stay of 3.9 days, and Turkey an average length of stay of 3.8 days. In 2000, Austria recorded an average length of stay of 4.5 days. Poland recorded an average length of stay of 8.5 days in 1999. If recent history is any indication, it may only be a few years before Eastern and Central European ophthalmologists begin discharging patients as quickly as their Western European counterparts. For instance, the average length of stay has been falling by about 15% per year in recent years in Hungary and the Slovak Republic; in the Czech Republic, Austria, and Turkey, the average length of stay has been dropping annually by about 5% to 10% in recent years. Having relatively long lengths of stay, however, is no impediment to performing high rates of cataract surgery. For instance, despite the average length of stay being 3.9 days in Hungary in 2001, Hungarian ophthalmologists in that same year performed 723.6 cataract operations per 100,000 of population - one of the highest rates in Europe, according to the OECD. In 2001, in Luxembourg, where cataract surgery patients stayed an average of 2.4 days in hospital and where 70% of cataract patients were admitted to the hospital for their surgery, ophthalmologists performed an even higher rate of cataract surgery - 730.4 operations per 100,000 of population. Who is the OECD? The OECD, or Organisation for Economic Cooperation and Development, is an international think tank and statistics gathering agency for 30 developed countries, including most European nations. Based in Paris, the 40-year-old OECD sponsors meetings between government officials to discuss economic and social issues of mutual interest. As part of its remit, the OECD also conducts research about economic and social factors that contribute to the development of its member states. The latest cataract surgery statistics were produced by the OECD's Health Policy Unit for its OECD Health Data 2003 report. The statistics included in the OECD report are based on data supplied to it voluntarily from the OECD-member countries.

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