The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Ophthalmology. 2012 May;119(5):914-22. doi: 10.1016/j.ophtha.2011.11.023. Epub 2012 Jan 31.
OBJECTIVE: To estimate endophthalmitis incidence after cataract surgery nationally and at the state level in 2003 and 2004 and to explore risk factors. DESIGN: Analysis of Medicare beneficiary claims data. PARTICIPANTS: We evaluated billed claims for cataract surgery and endophthalmitis diagnosis and treatment for all Medicare fee-for-service beneficiaries in 2003-2004. METHODS: Cataract surgeries were identified by procedure codes and merged with demographic information. Cataract annual surgical volume was calculated for all surgeons. Presumed postoperative endophthalmitis cases were identified by International Classification of Diseases-9 Clinical Modification Codes on claims within 42 days after surgery. Endophthalmitis rates and 95% confidence intervals (CI) were calculated at state and national levels. Logistic regression was used to investigate the association between developing endophthalmitis and surgery location and surgeon factors. MAIN OUTCOME MEASURES: Endophthalmitis incidence and risk factors. RESULTS: We included 4006 cases of presumed endophthalmitis, which occurred after 3 280 966 cataract surgeries. The national rate in 2003 was 1.33 per 1000 surgeries (95% 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 with 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 with ≥1001 annual surgeries) and less experience (RR, 1.41; 95% CI, 1.25-1.59 for 1-10 compared with ≥30 years), and surgeries performed in 2003 (RR, 1.20; 95% CI, 1.13-1.28) had increased endophthalmitis risk. CONCLUSIONS: Endophthalmitis rates are lower than previous yearly US estimates, but remain higher than rates reported from a series of studies from Sweden; patient factors or methodologic differences may contribute to differences across countries. Patient age, gender, and race, and surgeon volume and years of experience are important risk factors.
目的：评估 2003 年和 2004 年全国和州级白内障手术后眼内炎的发病率，并探讨其危险因素。
设计：医疗保险受益人的索赔数据分析。
参与者：我们评估了 2003-2004 年所有医疗保险付费服务受益人的白内障手术和眼内炎诊断及治疗的 billed 索赔。
方法：通过手术代码和人口统计信息识别白内障手术。计算每位外科医生的白内障年度手术量。在术后 42 天内，通过索赔中的国际疾病分类-9 临床修正码确定疑似术后眼内炎病例。在州和国家层面计算眼内炎发生率和 95%置信区间（CI）。使用逻辑回归调查发生眼内炎与手术地点和外科医生因素之间的关联。
主要观察指标：眼内炎发病率和危险因素。
结果：我们纳入了 4006 例疑似眼内炎，这些病例发生在 3280966 例白内障手术后。2003 年全国的发生率为每 1000 例手术 1.33 例（95%CI，1.27-1.38），2004 年降至每 1000 例手术 1.11 例（95%CI，1.06-1.16）。男性（相对风险[RR]，1.23；95%CI，1.15-1.31）、年龄较大者（RR，1.53；95%CI，1.38-1.69；≥85 岁与 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）患该病的风险增加。调整后，手术医生年手术量低（RR，3.80；95%CI，1-50 例与≥1001 例年手术相比）和经验较少（RR，1.41；95%CI，1-10 例与≥30 年相比），以及 2003 年进行的手术（RR，1.20；95%CI，1.13-1.28）发生眼内炎的风险增加。
结论：眼内炎发生率低于美国以往的年度估计，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存在差异。患者年龄、性别和种族以及外科医生的手术量和工作年限是重要的危险因素。
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