Unplanned Return to the Operating Room After Keratoplasty

To evaluate the incidence, risk factors, and common indications associated with an unplanned return to the operating room (OR) within 90 days after keratoplasty.

This retrospective cohort study was conducted at The Wilmer Eye Institute. Patients who underwent descemet stripping endothelial keratoplasty (DSEK), descemet membrane endothelial keratoplasty (DMEK), deep anterior lamellar keratoplasty (DALK), or penetrating keratoplasty (PK) between 2019 and 2022 were included. The overall rates of unplanned return to the OR were calculated, and temporal trends were analyzed. Mean time between keratoplasty and unplanned return to OR was also calculated. Multivariable logistic regression was used to identify factors associated with unplanned returns.

Among 984 keratoplasties, 69 (7%) patients had an unplanned return to the OR within 90 days. The return rate increased from 6% in 2019 to 9% in 2021 and dropped to 5% in 2022. Procedure-specific return rates were highest for DALK (22.5%, n = 9 of 40 total DALK cases), followed by DSEK (11.7%, n = 39 of 333 total DSEK cases), DMEK (4.1%, n = 15 of 363 total DMEK cases), and PK (2.4%, n = 6 of 248 total PK cases). Most unplanned returns (78.3%) occurred within the first 30 days after keratoplasty. Graft detachment is the most common indication for unplanned returns to the OR after EK. Regression analysis revealed no significant associations between age, sex, race, transplant type, American Society of Anesthesiologists physical status classification system, anesthesia type, or prior ocular surgery.

National data on unplanned return to the OR for different types of keratoplasty may serve as useful indicators of corneal surgical quality.