Author’s Disclosure Block: Angel Gao: none; Davin Johnson: D.J. is the medical director of the Focus Eye Center. However, D.J. does not hold any ownership or financial interest in the facility and does not present any conflict of interest in relation to the scientific content of this abstract.

Abstract Body
Purpose:This study aims to compare the clinical characteristics and systemic comorbidities of patients undergoing cataract surgery at an outpatient Independent Health Facility (IHF) versus those treated at a tertiary care hospital in Kingston, Ontario. Study Design: This study was a retrospective chart review. Methods: At our tertiary care centre, a unique arrangement exists whereby the hospital transfers some funding to an independent health facility (IHF) to complete cataract surgeries. Provincially funded cataract surgeries are thus completed at both sites, with hospital oversight. We conducted a retrospective chart review of all patients undergoing cataract surgery in 2023 at both the hospital (Kingston Health Sciences Centre) and IHF. Demographic data, clinical characteristics, and medication use were compared. Demographic data, clinical characteristics, and medication use were compared between the two centres. Results: A total of 3,441 patients were included (1,982 at hospital, 1,459 at IHF). Mean patient age was similar, although significantly more females underwent surgery at FEC (p = 0.004). Hospital patients had higher mean pre-operative blood pressure (148/74 vs. 141/79 mmHg, p < 0.0001), higher prevalence of diabetes, (1.5 odds ratio (OR) 95% CI 1.3 to 1.8, p < 0.0001), higher American Society of Anesthesiologist scores (0.3 mean difference, 95% CI 0.23 to 0.35, p < 0.0001), and more smoking (p < 0.0001 for current and prior smoking). Additionally, the use of anti-coagulation (1.6 OR. 95% CI 1.3 to 2.0, p < 0.0001), anti-diabetes medications (1.4 OR, 95% CI 1.2 to 1.7, p < 0.001) and prostate medications (1.4 OR, 95% CI 1.1 to 1.8, p = 0.002) were significantly higher among hospital patients. While anti-hypertensive medication use was similar, hospital patients used more anti-hypertensive medications on average (p = 0.018). Conclusions: Our data supports concerns that healthier patients are more likely to undergo surgery at out-of-hospital private centers. A number of factors may contribute to this include restrictions on patient selection at IHFs mandated by governing bodies, surgeon preference, and referral patterns. As out-of-hospital surgical care grows, documenting these differences is essential to ensure fair distribution of funding and resources to hospitals and IHFs, and to ensure equal access to care for all patients.