Adverse Events After Pars Plana Vitrectomy Among Medicare Beneficiaries
Adverse Events After Pars Plana Vitrectomy Among Medicare Beneficiaries
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DOI：
10.1001/archophthalmol.2009.300
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发表时间：
2009-12-01
影响因子：
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通讯作者：
Sloan, Frank A.
中科院分区：
文献类型：
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作者：
Stein, Joshua D.;Zacks, David N.;Sloan, Frank A.
目的：评估的并发症发生率的睫状体平坦部玻璃体切除术（PPV）在美国老年人，并确定是否发生率的不良事件和额外的操作已经改变，在过去的decade.Methods：索赔数据进行了审查，以确定所有成年人年龄在68岁或以上的5%的医疗保险样本谁经历了他们的第一个PPV在19941995年，1999-2000年，和2004-2005年。采用考克斯回归分析计算并比较3组患者1年内严重并发症（眼内炎、脉络膜上腔出血或视网膜脱离）、较轻并发症、接受所有额外手术和失明的发生率。分析调整为以前的不良事件（在过去3年），人口统计学特征，和共病conditions.Results：1994-1995年，1999-2000年，和2004-2005年队列分别有3263，5064，和5263例患者。3组之间的1年严重并发症发生率无差异（范围，4.8%-5.5%）。2004-2005年队列中较轻并发症或额外手术的风险高于早期队列（所有比较P <0.05）。眼内炎的风险是更高的黑人（P = 0.07）和其他种族（P = 0.02）比在白色patients.Conclusions：在过去的十年中，PPV后严重并发症的发生率保持稳定，但不太严重的并发症和随后的手术率增加。未来的研究应该探索解释这些变化的潜在因素，以及非白人个体中PPV后眼内炎发病率惊人的升高。
Objectives: To assess the complication rates of pars plana vitrectomy (PPV) among older Americans and to determine whether rates of adverse events and additional operations have changed during the past decade.Methods: Claims data were reviewed to identify all adults aged 68 years or older in the 5% Medicare sample who underwent their first PPV during 19941995, 1999-2000, and 2004-2005. One-year rates of severe complications (endophthalmitis, suprachoroidal hemorrhage, or retinal detachment), less severe complications, receipt of ail additional operation, and blindness were calculated and compared among the 3 groups using Cox regression. Analyses were adjusted for prior adverse events (during the previous 3 years), demographic characteristics, and comorbid conditions.Results: The 1994-1995, 1999-2000, and 2004-2005 cohorts had 3263, 5064, and 5263 patients, respectively. The 1-year severe complication rates did not differ among the 3 groups (range, 4.8%-5.5%). The hazard of a less severe complication or an additional operation was higher in the 2004-2005 cohort than in the earlier cohorts (P < .05 for all comparisons). The hazard of endophthalmitis was higher in black individuals (P = .07) and those of other races (P = .02) than in white patients.Conclusions: During the past decade, rates of severe complications after PPV remained stable, but rates of less severe complications and subsequent operations increased. Future studies should explore the potential factors that explain these changes and the alarming elevated incidence of post-PPV endophthalmitis among nonwhite individuals.