2000 年至 2014 年 Medicare 受益人群的玻璃体视网膜手术趋势。
Trends in Vitreoretinal Procedures for Medicare Beneficiaries, 2000 to 2014.
机构信息
Retina Associates of Orange County, Laguna Hills, California.
Retina Associates of Orange County, Laguna Hills, California; University of Southern California, Roski Eye Institute, Keck School of Medicine, Los Angeles, California.
出版信息
Ophthalmology. 2017 May;124(5):667-673. doi: 10.1016/j.ophtha.2017.01.001. Epub 2017 Mar 7.
TOPIC
The purpose of this study was to identify changes in use for vitreoretinal procedures by measuring the number of allowed services using data from the US Medicare Part B Fee-for-Service (FFS) beneficiaries and their providers.
CLINICAL RELEVANCE
To analyze vitreoretinal procedural trends, which may indicate standard of care and importance of developing methods of treatments.
METHODS
Medicare Part B National Summary Data Files for calendar years 2000 to 2014 were used to identify the number of allowed services for vitreoretinal procedures and commonly used pharmacologic agents. Linear regression analysis was performed to identify trends in use.
MAIN OUTCOME MEASURES
To analyze vitreoretinal procedural trends, which may indicate standard of care and importance of developing methods of treatments.
RESULTS
Vitreoretinal procedures grew 6-fold from 2000 to 2014. Intravitreal injections were the primary driver of growth. A total of 2922 injections were performed in 2000, compared with 2 619 950 injections in 2014 (P < 0.01). Scleral buckling declined from 6502 procedures in 2000 to 1260 procedures in 2014 (P < 0.01), whereas vitrectomy use for retinal detachment increased from 13 814 surgeries in 2008 to 19 288 surgeries in 2014 (P < 0.01). Focal laser treatments declined from 188 351 procedures in 2002 to 83 379 procedures in 2014 (P < 0.01). Panretinal photocoagulation treatments declined from 109 840 procedures in 2004 to 81 005 procedures in 2014 (P < 0.01).
CONCLUSIONS
Vitreoretinal practice patterns changed significantly from 2000 to 2014. Intravitreal injections increased by 89 563%. Intravitreal injections accounted for 0.55% of all vitreoretinal procedures in 2000 and increased to 87% in 2014. Scleral buckling sharply declined, and preference for retinal detachment repair shifted further toward vitrectomy with a distribution of 83% vitrectomy, 5% scleral buckling, and 12% pneumatic retinopexy in 2014. Use of laser photocoagulation significantly declined for treatment of macular edema and proliferative retinopathy. Cryotherapy procedures declined across all indications.
标题
本研究旨在通过使用美国医疗保险 B 部分按服务收费（FFS）受益人和其提供者的数据来衡量允许服务的数量，以确定玻璃体视网膜手术的使用变化，以分析玻璃体视网膜手术的趋势，这些趋势可能表明治疗标准和开发治疗方法的重要性。
方法
使用 2000 年至 2014 年的医疗保险 B 部分国家汇总数据文件，确定玻璃体视网膜手术和常用药物的允许服务数量。进行线性回归分析以确定使用趋势。
主要观察指标
分析玻璃体视网膜手术的趋势，这些趋势可能表明治疗标准和开发治疗方法的重要性。
结果
玻璃体视网膜手术从 2000 年到 2014 年增长了 6 倍。玻璃体内注射是增长的主要驱动因素。2000 年进行了 2922 次注射，而 2014 年进行了 2619950 次注射（P<0.01）。巩膜扣带术从 2000 年的 6502 例下降到 2014 年的 1260 例（P<0.01），而视网膜脱离的玻璃体切除术从 2008 年的 13814 例增加到 2014 年的 19288 例（P<0.01）。2002 年，焦点激光治疗从 188351 例下降到 2014 年的 83379 例（P<0.01）。2004 年，全视网膜光凝术从 109840 例下降到 2014 年的 81005 例（P<0.01）。
结论
2000 年至 2014 年间，玻璃体视网膜手术的治疗模式发生了重大变化。玻璃体内注射增加了 89563%。玻璃体内注射在 2000 年占所有玻璃体视网膜手术的 0.55%，到 2014 年增加到 87%。巩膜扣带术急剧下降，视网膜脱离修复的偏好进一步偏向玻璃体切除术，2014 年玻璃体切除术的分布为 83%，巩膜扣带术为 5%，气动视网膜复位术为 12%。黄斑水肿和增殖性视网膜病变的激光光凝治疗使用率显著下降。冷冻疗法在所有适应症中的使用均下降。
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