Postcataract surgery endophthalmitis in the United States: analysis of the complete 2003 to 2004 Medicare database of cataract surgeries.
Postcataract surgery endophthalmitis in the United States: analysis of the complete 2003 to 2004 Medicare database of cataract surgeries.
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DOI：
10.1016/j.ophtha.2011.11.023
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发表时间：
2012-05
期刊：
影响因子：
13.7
通讯作者：
Schein OD
中科院分区：
文献类型：
--
作者：
Keay L;Gower EW;Cassard SD;Tielsch JM;Schein OD
估计2003-2004年全国和州一级白内障手术后眼内炎的发病率，并探讨危险因素。医疗保险受益人索赔数据分析。100%样本的医疗保险受助人的索赔眼内炎和门诊白内障手术服务。白内障手术通过手术代码识别，并与人口统计学信息合并。计算所有外科医生的白内障年手术量。根据术后42天内索赔的国际疾病分类-9临床修改代码（ICD-9-CM）确定假定的术后眼内炎病例。在州和国家水平上计算眼内炎发生率和95%置信区间。采用Logistic回归分析眼内炎的发生与手术部位、术者因素的关系。眼内炎的发病率及危险因素。在3，280，966例白内障手术后发生了4，006例推定眼内炎。2003年的全国发病率为1.33/1000例手术（95%置信区间[CI]：1.27-1.38），2004年降至1.11/1000例手术（95% CI：1.06-1.16）。男性（相对风险[RR] 1.23，95% CI：1.15-1.31），老年人（RR 1.53，95% CI 1.38-1.69; 85+与65-74岁相比），黑人（RR 1.17，95% CI 1.03-1.33）和美洲原住民（RR 1.72，95% CI 1.07-2.77）的疾病风险增加。调整后，年手术量低的外科医生的手术（RR 3.80，95%CI 3.13-4.61，1-50例与每年1001+例手术相比）和经验较少（RR 1.41，95% CI 1.25-1.59 1-10，与30岁以上相比）和2003年进行的手术（RR 1.20，95% CI 1.13-1.28）增加了眼内炎风险。眼内炎发生率低于美国前一年的估计值，但仍高于瑞典一系列研究报告的发生率;患者因素或方法学差异可能导致各国之间的差异。患者年龄、性别和种族、外科医生数量和经验年限是重要的风险因素。
To estimate endophthalmitis incidence following cataract surgery nationally and at the state level in 2003–2004 and to explore risk factors. Analysis of Medicare beneficiary claims data. 100% sample of Medicare recipients’ claims for endophthalmitis and outpatient cataract surgery services. Cataract surgeries were identified by procedure codes and merged with demographic information. Cataract annual surgical volume was calculated for all surgeons. Presumed post-operative endophthalmitis cases were identified by International Classification of Diseases-9 Clinical Modification Codes (ICD-9-CM) on claims within 42 days after surgery. Endophthalmitis rates and 95% confidence intervals were calculated at state and national levels. Logistic regression was used to investigate the association between developing endophthalmitis and surgery location and surgeon factors. Endophthalmitis incidence and risk factors. 4,006 cases of presumed endophthalmitis occurred following 3,280,966 cataract surgeries. The national rate in 2003 was 1.33 per 1000 surgeries (95% confidence interval [CI]: 1.27–1.38) and decreased to 1.11 per 1000 (95% CI: 1.06–1.16) in 2004. Males (relative risk [RR] 1.23, 95% CI: 1.15–1.31), older individuals (RR 1.53, 95% CI 1.38–1.69; 85+ compared to 65–74 years), Blacks (RR 1.17, 95% CI 1.03–1.33) and Native Americans (RR 1.72, 95% CI 1.07–2.77) had increased risk of disease. After adjustment, surgeries by surgeons with low annual volume (RR 3.80, 95% CI 3.13–4.61 for 1–50 compared to 1001+annual surgeries) and less experience (RR 1.41, 95% CI 1.25–1.59 1–10 compared to 30+ years) and surgeries per formed in 2003 (RR 1.20, 95% CI 1.13–1.28) had increased endophthalmitis risk. Endophthalmitis rates are lower than previous-year US estimates, but remain higher than rates reported from a series of studies from Sweden; patient factors or methodological differences may contribute to differences across countries. Patient age, gender and race, and surgeon volume and years of experience are important risk factors.
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