Longitudinal rates of postoperative adverse outcomes after glaucoma surgery among medicare beneficiaries 1994 to 2005.
Longitudinal rates of postoperative adverse outcomes after glaucoma surgery among medicare beneficiaries 1994 to 2005.
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DOI：
10.1016/j.ophtha.2008.03.033
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发表时间：
2008-07
期刊：
影响因子：
13.7
通讯作者：
Sloan FA
中科院分区：
文献类型：
--
作者：
Stein JD;Ruiz D Jr;Belsky D;Lee PP;Sloan FA
旨在确定全国代表性纵向样本中切开青光眼手术后术后不良后果的纵向发生率。回顾性纵向队列分析。 1994 年至 2003 年期间接受过初次小梁切除术 (PT)、带疤痕小梁切除术 (TS) 或青光眼引流装置 (GDD) 植入并随访至 2005 年的年龄≥68 岁的医疗保险受益人。初次小梁切除术、TS 和 GDD 是根据国际疾病分类 (ICD-9-CM) 和现行程序术语 (CPT) 程序确定的代码。通过累积发生率和 Cox 比例风险模型回归分析与这 3 种手术干预相关的术后不良结局发生率的变化；回归分析控制了先前的不良结果测量（3 年准备）和人口变量。通过每个治疗组的医疗保险索赔，确定了第一年、第二年和第六年出现严重不良后果（视网膜脱离、眼内炎、脉络膜上腔出血）、较不严重不良后果（脉络膜脱离、角膜水肿、眼压过低）以及接受额外青光眼手术的累积发生率和概率。在 1 年随访中，GDD 组受益人的严重不良后果发生率 (2.0%) 高于 PT (0.6%) 和 TS 组 (1.3%)。在 Cox 比例分析中控制先前手术的不良后果和人口因素，差异通常会减少，但总体上仍具有统计学和临床显着性。接受 GDD 的患者发生严重后果、不太严重的后果、角膜水肿和低视力/失明的发生率高于 PT 或 TS。然而，TS 的再手术率高于 GDD。在控制了一些重要的病例组合和人口因素后，GDD 的不良后果风险高于 PT 手术或 TS。
To determine longitudinal rates of postoperative adverse outcomes after incisional glaucoma surgery in a nationally representative longitudinal sample. Retrospective, longitudinal cohort analysis. Medicare beneficiaries ≥68 years who underwent a primary trabeculectomy (PT), trabeculectomy with scarring (TS), or glaucoma drainage device (GDD) implantation from 1994 to 2003 with follow-up through 2005. Primary trabeculectomy, TS, and GDD were identified from International Classification of Diseases (ICD-9-CM) and Current Procedural Terminology (CPT) procedure codes. Change in rates of postoperative adverse outcomes associated with these 3 surgical interventions was analyzed by cumulative incidence rates and Cox proportional hazards model regression; regression analysis controlled for prior adverse outcome measures (3-year run-up) and demographic variables. First-, second-, and sixth-year cumulative rates and probability of experiencing serious adverse outcomes (retinal detachment, endophthalmitis, suprachoroidal hemorrhage), less serious adverse outcomes (choroidal detachment, corneal edema, hypotony), and receipt of additional glaucoma surgery were identified through Medicare claims for each treatment group. At the 1-year follow-up, rates of severe adverse outcomes were higher among beneficiaries in the GDD group (2.0%) relative to the PT (0.6%) and TS groups (1.3%). Controlling for prior adverse outcomes to the surgery and demographic factors in Cox proportional analysis, differences were often reduced, but generally remained statistically and clinically significant. Rates of severe outcomes, less severe outcomes, corneal edema, and low vision/blindness were higher for persons undergoing GDD than PT or TS. However, rates of reoperation were higher for TS than GDD. The risk for adverse outcomes was higher in GDD than in PT surgery or TS, controlling for a number of important case mix and demographic factors.
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作者：
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通讯作者：
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影响因子：
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作者：
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作者：
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通讯作者：
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影响因子：
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通讯作者：
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