Prospective analysis of outcomes and economic factors of same-day bilateral cataract surgery in the United States
Prospective analysis of outcomes and economic factors of same-day bilateral cataract surgery in the United States
复制标题
DOI：
10.1016/j.jcrs.2014.07.034
复制
发表时间：
2015-04-01
影响因子：
2.8
通讯作者：
Rush, Ryan B.
中科院分区：
文献类型：
--
作者：
Rush, Sloan W.;Gerald, Ashley E.;Rush, Ryan B.
目的：评估美国当日双侧白内障手术与当日双侧白内障手术的视力和经济效益。环境：私人诊所，美国德克萨斯州阿马里洛。设计：前瞻性对照非随机临床试验。方法：一组接受同日双侧白内障手术的患者与一组接受标准分日双侧白内障手术的对照患者年龄相匹配。主要结果是比较患者、医生、门诊手术中心（ASC）和第三方付款人的直接成本。结果：当日队列（42例患者，84只眼）与对照队列（42例患者，84只眼）具有相似的基线特征和术后结局。与对照队列相比，同日队列的护理总路程更短（城镇居民和非城镇居民分别为P = 0.0039和P < 0.0001），护理总路程更短（城镇居民和非城镇居民分别为P = 0.0008和P < 0.0001），护理总就诊次数更少（P < 0.0001），视力恢复总时间更短（P < 0.0001）。当天队列中医生和ASC报销较低（P = 0.0028和P = 0.0016），而两组之间医生在手术中照顾患者的总时间没有差异（P = .7310）。当天队列的ASC总费用较高（P < 0.0001）。在同日队列中，第三方付款人的总成本显著降低（P < 0.0001）。结论：目前在美国，当日行双侧白内障手术可获得患者的视力和经济效益。
PURPOSE: To evaluate the visual and economic benefits of same-day bilateral cataract surgery versus separate-day bilateral cataract surgery in the United States.SETTING: Private practice, Amarillo, Texas, USA.DESIGN: Prospective controlled nonrandomized clinical trial.METHODS:A cohort of patients having same-day bilateral cataract surgery was age-matched with a cohort of control patients who had standard separate-day bilateral cataract surgery. The primary outcome was a comparison of the direct cost for the patient, physician, ambulatory surgery center (ASC), and third-party payer.RESULTS: The same-day cohort (42 patients, 84 eyes) had similar baseline characteristics and postoperative outcomes as the control cohort (42 patients, 84 eyes). The same-day cohort had less total distance traveled for care (P = .0039 and P < .0001 for in-town and out-of-town residents, respectively), less total time spent traveling for care (P = .0008 and P < .0001 for in-town and out-of-town residents, respectively), less total number of visits required for care (P < .0001), and less total time for vision recovery (P < .0001) than the control cohort. The physician and ASC reimbursements were lower in the same-day cohort (P = .0028 and P = .0016, respectively), whereas the total physician time spent caring for the patient in surgery was not different between the 2 groups (P = .7310). The total ASC expenses were higher in the same-day cohort (P < .0001). The total third-party payer cost was significantly less in the same-day cohort (P < .0001).CONCLUSION: Visual and economic benefits for the patient can be achieved with same-day bilateral cataract surgery in the U.S. at the present time.