Risk-Stratified Postoperative Follow-Up After Uncomplicated Cataract Surgery: Real-World Outcomes and Implications for Remote Care

Pablo Bratos Rubio,1,2,* Francisco Arnalich-Montiel,1– 3,* David Mingo-Botin,1,2 Francisco J Muñoz Negrete1– 3 1Department of Ophthalmology, Ramón Y Cajal University Hospital, Madrid, Spain; 2Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; 3Department of Ophthalmology, Universidad de Alcalá, Madrid, Spain*These authors contributed equally to this workCorrespondence: Pablo Bratos Rubio, Department of Ophthalmology, Ramón Y Cajal University Hospital, Ctra. de Colmenar Viejo km 9.1, Madrid, 28034, Spain, Tel +34 692398444, Email [email protected]: To evaluate the clinical value of postoperative examinations at 24 hours and 30 days following uncomplicated phacoemulsification, and to identify subgroups who may safely benefit from remote or simplified follow-up pathways.Methods: A retrospective observational study was conducted, including all patients who underwent uncomplicated phacoemulsification at a high-volume tertiary public hospital during September 2024. Demographic data, ophthalmologic history, surgical characteristics, day-1 and day-30 findings, visual outcomes, and emergency visits were extracted from electronic medical records. Postoperative complications associations were evaluated using bivariate tests and multivariate binomial logistic regression.Results: Of 296 patients, the most common 24-hour complication was transient intraocular pressure elevation (13.2%). Overall, 20.9% showed a postoperative finding on day 1, and 14.2% required unplanned reassessment. At 30 days, complications occurred in 6.7% of cases, mainly cystoid macular edema (3.6%). In multivariate analysis, 24-hour complications (P=0.028) and ophthalmologic comorbidities (P=0.010) independently predicted 30-day complications. Patients without ophthalmologic history, without 24-hour complications, and with early visual improvement had a markedly lower risk of adverse outcomes. Applying a risk-based follow-up strategy could reduce approximately 50% of routine 30-day in-person reviews and relieve up to 300 hours of annual clinical workload.Conclusion: This risk-stratified postoperative model may improve service efficiency in high-volume public hospitals, support the sustainability of ophthalmic care, and may be transferable to other public health systems. Low-risk patients could be safely monitored remotely without compromising clinical outcomes. Prospective studies are required to confirm these findings.Keywords: cataract, phacoemulsification, postoperative complications, follow-up, telemedicine, risk stratification