Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor.
National Clinician Scholars Program, University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor.
JAMA Ophthalmol. 2018 Jan 1;136(1):53-60. doi: 10.1001/jamaophthalmol.2017.5101.
Cataract surgery is commonly performed at ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs). These venues differ in many ways, including surgical efficiency, patient throughput, patient safety, and costs per surgery.
To determine trends in use of ASCs and HOPDs for cataract surgery from 2001 to 2014 and factors affecting the site of surgery.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective longitudinal cohort analysis involved individuals 40 years and older who underwent cataract surgery between January 2001 and December 2014 from a nationwide US managed care network. Data were analyzed from February 2016 to February 2017.
We identified all enrollees who underwent cataract surgery and determined whether the surgery was performed at an ASC or HOPD. We calculated the proportion of surgeries performed at each site each year from 2001 to 2014. Multivariable logistic regression identified characteristics of enrollees who had cataract surgery at an ASC vs a HOPD. We also assessed geographic variation in the proportion of cataract surgeries performed at ASCs in 306 communities throughout the United States.
Of the 369 320 enrollees included in this study, 208 319 (56.4%) were female, and the mean (SD) age was 66.3 (10.4) years. All enrollees underwent cataract surgery (531 325 surgeries) from 2001 to 2014. Of these, 237 046 (64.2%) underwent cataract surgery at an ASC. The proportion of cataract surgeries performed at ASCs increased from 43.6% in 2001 to 73.0% in 2014. Compared with enrollees with incomes less than $40 000, those with incomes greater than $100 000 were 20% more likely to undergo cataract surgery at an ASC (odds ratio, 1.20; 95% CI, 1.12-1.29). Enrollees with better overall health were no more likely to undergo cataract surgery at an ASC (odds ratio, 1.00; 95% CI, 0.99-1.00) than at an HOPD. Enrollees who lived in communities without certificate of need laws were more than twice as likely to have surgery at an ASC (odds ratio, 2.49; 95% CI, 2.35-2.63). The proportion of cataract surgeries performed at ASCs from 2012 to 2014 varied considerably, from 1.6% in La Crosse, Wisconsin, to 98.8% in Pueblo, Colorado.
We observed a large shift in the site of cataract surgery from HOPDs to ASCs from 2001 to 2014. Future research is needed to assess the effect of this transition in site of surgical care on patient access to surgery, surgical outcomes, patient safety, and societal costs.
白内障手术通常在门诊手术中心 (ASC) 和医院门诊部门 (HOPD) 进行。这些场所在许多方面存在差异，包括手术效率、患者吞吐量、患者安全和每次手术的成本。
确定 2001 年至 2014 年间 ASC 和 HOPD 用于白内障手术的趋势，以及影响手术部位的因素。
设计、设置和参与者：本回顾性纵向队列分析涉及全国性美国管理式医疗网络中 2001 年 1 月至 2014 年 12 月期间年龄在 40 岁及以上的个体。数据于 2016 年 2 月至 2017 年 2 月进行分析。
我们确定了所有接受白内障手术的参保人，并确定手术是在 ASC 还是 HOPD 进行的。我们计算了 2001 年至 2014 年每年在每个地点进行的手术比例。多变量逻辑回归确定了在 ASC 接受白内障手术的参保人与在 HOPD 接受白内障手术的参保人的特征。我们还评估了美国 306 个社区中 ASC 进行白内障手术的比例的地理差异。
本研究共纳入 369320 名参保人，其中 208319 名（56.4%）为女性，平均（SD）年龄为 66.3（10.4）岁。所有参保人在 2001 年至 2014 年间接受了白内障手术（531325 例）。其中，237046 例（64.2%）在 ASC 接受白内障手术。2001 年至 2014 年间，在 ASC 进行的白内障手术比例从 43.6%增加到 73.0%。与收入低于 40000 美元的参保人相比，收入超过 100000 美元的参保人在 ASC 进行白内障手术的可能性增加 20%（优势比，1.20；95%置信区间，1.12-1.29）。整体健康状况较好的参保人在 ASC 进行白内障手术的可能性并不高于 HOPD（优势比，1.00；95%置信区间，0.99-1.00）。在没有需求证明法的社区居住的参保人在 ASC 进行手术的可能性是 HOPD 的两倍多（优势比，2.49；95%置信区间，2.35-2.63）。2012 年至 2014 年，在 ASC 进行的白内障手术比例差异很大，从威斯康星州拉克罗斯的 1.6%到科罗拉多州普韦布洛的 98.8%。
我们观察到从 2001 年到 2014 年，白内障手术的地点从 HOPD 大量转移到 ASC。需要进一步研究以评估手术护理场所这一转变对患者获得手术、手术结果、患者安全和社会成本的影响。
