Neimkin Michael G, Couch Steven M, Holds John B, Bodnar Zachary M, Reggie Sara N
*Ophthalmic Plastic and Cosmetic Surgery Inc., †Department of Ophthalmology and Visual Sciences, Washington University in Saint Louis, ‡Department of Ophthalmology, Saint Louis University, and §Department of Otolaryngology/Head and Neck Surgery, Saint Louis University, Saint Louis, Missouri, U.S.A.
Ophthalmic Plast Reconstr Surg. 2017 Mar/Apr;33(2):124-128. doi: 10.1097/IOP.0000000000000668.
The goal of this study is to identify and describe the role of surgical incision preference, insurance reimbursement, and geographical location on the current ptosis repair practice patterns of American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) members.
A 9-question survey was designed with surveymonkey.com and a participation link was emailed to all active ASOPRS members' email addresses in February 2015. After a reminder email, the survey was closed and the results were analyzed. There are 3 major questions the survey data is to be used answer: 1) Surgical approach preference: The first question established preferred surgical technique (internal vs. external approach) for ptosis repair. This result was/is used to stratify the remaining responses into 2 groups. 2) Functional versus cosmetic surgical indication: Three clinical scenarios were presented for a functional versus cosmetic patient for ptosis repair and blepharoplasty. 3) Location: The responses were analyzed based on location to determine any geographic bias for surgical preference. For this analysis, the US was separated into 4 regions (West, Midwest, North, and South), as defined by the United States Census Bureau; all international respondents were grouped together.
Three hundred and ten responses were included and analyzed; 61% preferred the internal surgical approach, there was no statistical significance to geographic location (p = 0.17). Surgeons who prefer the external surgical approach (76.1%) were more likely than internal (62.5%) to include a bundled (nonreimbursed) blepharoplasty at no additional charge in the setting of functional ptosis repair (p = 0.015). Treatment plans differed significantly in both groups between functional and cosmetic patients with visually significant ptosis (Margin Reflex Distance < 1.5) and moderate dermatochalasis; with both the internal and external group electing combined surgery at a higher rate in cosmetic patients (p < 0.01 for functional vs. cosmetic within each group, and internal vs. external repair). There was no statistical difference in the timeframe for adjusting external ptosis for functional or cosmetic patients (p = 0.79). More surgeons use nonabsorbable closure for cosmetic blepharoplasty patients (68.7%) than for functional (54.1%) surgery patients (p < 0.01).
Previous studies have documented the immediate effect of Medicare reimbursement changes on the management of concurrent ptosis and dermatochalasis. This study illustrates current practice patterns for ptosis repair and blepharoplasty. The necessity of creating a separate surgical site for surgeons who prefer the internal approach to ptosis surgery to perform a functional blepharoplasty has a significant influence on surgeon's willingness to perform concurrent blepharoplasty as a nonreimbursed bundled procedure.
本研究的目的是确定并描述手术切口偏好、保险报销以及地理位置对美国眼科整形与重建外科学会（ASOPRS）成员当前上睑下垂修复实践模式的作用。
2015年2月，通过surveymonkey.com设计了一份包含9个问题的调查问卷，并将参与链接发送至所有活跃的ASOPRS成员的电子邮箱地址。在发送提醒邮件后，调查问卷截止，然后对结果进行分析。调查数据将用于回答3个主要问题：1）手术方法偏好：第一个问题确定上睑下垂修复的首选手术技术（内路法与外路法）。该结果被用于将其余回答分为两组。2）功能性与美容性手术适应症：针对上睑下垂修复和眼睑成形术的功能性与美容性患者，呈现了3种临床场景。3）地理位置：根据地理位置对回答进行分析，以确定手术偏好是否存在任何地理偏向性。在此分析中，按照美国人口普查局的定义，美国被划分为4个区域（西部、中西部、北部和南部）；所有国际受访者归为一组。
共纳入并分析了310份回答；61%的人更喜欢内路手术方法，地理位置无统计学意义（p = 0.17）。在功能性上睑下垂修复中，更喜欢外路手术方法的外科医生（76.1%）比喜欢内路手术方法的外科医生（62.5%）更有可能免费额外进行一次捆绑式（无报销）眼睑成形术（p = 0.015）。在功能性和美容性上睑下垂明显（边缘反射距离<1.5）且有中度皮肤松弛的患者中，两组的治疗方案差异显著；内路组和外路组在美容性患者中选择联合手术的比例更高（每组功能性与美容性、内路修复与外路修复相比，p<0.01）。功能性或美容性患者调整外路法上睑下垂的时间范围无统计学差异（p = 0.79）。与功能性手术患者（54.1%）相比，更多外科医生在美容性眼睑成形术患者中使用不可吸收缝线缝合（68.7%）（p<0.01）。
先前的研究记录了医疗保险报销变化对上睑下垂合并皮肤松弛管理的即时影响。本研究阐述了当前上睑下垂修复和眼睑成形术的实践模式。对于更喜欢内路法上睑下垂手术的外科医生来说，为进行功能性眼睑成形术而创建一个单独的手术部位的必要性，对其作为无报销捆绑手术进行同期眼睑成形术的意愿有重大影响。
