Variation in Perioperative Care Practices Among Vitreoretinal Surgeons in the United States

OBJECTIVE: To describe perioperative practice pat-terns among retinal surgeons managing retinal de-tachment (RD) repair. METHODS: This was a cross-sectional pilot survey of vitreoretinal surgeons in the United States (US), identified by a previously published web-based search and cross-referencing names from the Ameri-can Society of Retina Specialists. Self-reported peri-operative practices and subgroups were analyzed. RESULTS: Of the 298 surgical retina specialists who completed the survey, 115 (39%) were in practice for <= 5 years, 102 (34%) were in practice for 6 to 20 years, and 81 (27%) were in practice for > 20 years; 60%, 23%, and 16% were in private, academic, and hybrid practice, respectively. Fifty-nine percent reported op-erating with trainees. For ocular blocks, 59% perform retrobulbar, 21% peribulbar, and 20% subtenon's (ST). Use of ST block varied significantly by years in practice and presence of trainees (P < 0.0001, P = 0.004, respectively). Sixty percent perform primary scleral buckles (SB), 55% combined SB/pars plana vitrectomy (PPV), and 11% primary PPVs under gen-eral anesthesia. Use of general anesthesia for primary SB varied significantly by years in practice (P = 0.007). Surgeons with fewer years in practice were more like-ly to recommend facedown positioning for macula-off RDs (P < 0.0001). Forty-six percent of surgeons do not advise stopping blood thinners before surgery and this varied significantly by years in practice (P = 0.006). CONCLUSIONS: Variation exists among US vitreoreti-nal surgeons in relation to anesthesia, postoperative positioning, and blood thinners restrictions. Prefer-ences are influenced by years in practice and less by trainees and practice setting. These results serve as a basis for larger, targeted US-based surveys on periop-erative care and correlation with surgical outcomes.