Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Glaucoma Center of Excellence, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.
Am J Ophthalmol. 2020 Nov;219:132-140. doi: 10.1016/j.ajo.2020.06.016. Epub 2020 Jun 20.
To determine the unplanned return to operating room (OR) rate within 180 days and at any time postoperatively after trabeculectomy performed or supervised by an attending surgeon and to identify associated factors.
Retrospective case-control study.
Review of 881 eyes that underwent trabeculectomy at an academic glaucoma service between January 2014 and December 2016. Inclusion criteria included adult patients with postoperative follow-up >180 days and no other glaucoma-related surgery within the prior year. For each eye that underwent reoperation, a control was time-matched within 1 month.
The reoperation rate within 180 days was 9.5% (84/881) and at any time postoperatively was 23.3% (205/881). When intraoperative bleb needling cases were excluded, the reoperation rate was 6.5% (57/881) within 180 days and 13.6% (120/881) at any time postoperatively. Mean postoperative follow-up was 2.9 ± 1.1 years. The most common reoperations within 180 days were bleb revision (32.1%) and intraoperative bleb needling (28.6%) and at any time postoperatively were bleb needling (36.1%), bleb revision (23.9%), and tube shunt implant (13.2%). At last follow-up, eyes that returned to OR and control eyes were similar in terms of mean intraocular pressure (IOP), the proportion of eyes meeting target IOP, and change in visual acuity since the original trabeculectomy.
Nearly 10% of eyes returned to OR within 180 days and over 20% of eyes required reoperation at any time postoperatively with a mean follow-up of nearly 3 years. Additional studies should evaluate unplanned return to OR as a measure of surgical quality within ophthalmology.
确定在行小梁切除术的主治外科医生进行或监督的手术后 180 天内和任何时间内计划外返回手术室（OR）的比率，并确定相关因素。
回顾性病例对照研究。
对 2014 年 1 月至 2016 年 12 月在学术青光眼服务机构接受小梁切除术的 881 只眼进行了回顾性分析。纳入标准包括术后随访时间超过 180 天且在过去 1 年内没有进行其他与青光眼相关的手术的成年患者。对于每只需要再次手术的眼睛，在 1 个月内进行时间匹配的对照。
在 180 天内再次手术的比率为 9.5%（84/881），在任何时间手术后为 23.3%（205/881）。当排除术中滤泡针刺病例时，180 天内再次手术的比率为 6.5%（57/881），任何时间手术后为 13.6%（120/881）。平均术后随访时间为 2.9±1.1 年。在 180 天内最常见的再次手术是滤泡重建（32.1%）和术中滤泡针刺（28.6%），在任何时间手术后最常见的是滤泡针刺（36.1%）、滤泡重建（23.9%）和引流管植入（13.2%）。在最后一次随访时，返回 OR 的眼睛和对照眼睛在平均眼压（IOP）、达到目标 IOP 的眼睛比例以及自原小梁切除术以来视力变化方面相似。
近 10%的眼睛在 180 天内返回 OR，超过 20%的眼睛在任何时间需要再次手术，平均随访时间近 3 年。需要进一步的研究来评估计划外返回 OR 作为眼科手术质量的衡量标准。
