基于人群的分析：巩膜扣带术和玻璃体切除术治疗孔源性视网膜脱离的长期成本和不良事件。
A Population-Based Analysis of Long-Term Costs and Adverse Events after Pneumatic Retinopexy and Pars Plana Vitrectomy.
机构信息
Department of Ophthalmology and Vision Sciences, University of Toronto, Ontario, Canada.
Department of Ophthalmology and Vision Sciences, University of Toronto, Ontario, Canada; Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Ontario, Canada.
出版信息
Ophthalmol Retina. 2023 Sep;7(9):794-803. doi: 10.1016/j.oret.2023.05.021. Epub 2023 Jun 5.
PURPOSE
To comprehensively examine the cost effectiveness, reattachment rate, and complications of pneumatic retinopexy (PnR) compared with pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) within a universal health care system.
DESIGN
Population-based, multicenter, consecutive, retrospective longitudinal cohort analysis.
SUBJECTS
We identified consecutive adults aged ≥ 50 years requiring surgery for primary RRD over a 20-year interval between April 1, 2002, and March 31, 2022. Initial surgery was considered the index date for analyses.
INTERVENTION
Pneumatic retinopexy was compared with PPV in all analyses.
MAIN OUTCOME MEASURES
The primary analysis investigated the mean annualized health care costs comparing PnR to PPV over the 2 years after initial surgery. Secondary analyses examined the primary reattachment rate and complications.
RESULTS
In total, 25 665 eligible patients were identified, with 8794 undergoing PnR and 16 871 undergoing PPV. The mean patient age was 65 years and 39% were women. The mean annualized cost after PnR was $8924 and $11 937 after PPV (mean difference, $3013; 95% confidence interval, $2533-$3493; P < 0.001). The primary reattachment rate at 90 days after PnR was 83% and after PPV was 93% (P < 0.001). The risk of cataract or glaucoma surgery was lower after PnR, and the frequency of ophthalmology clinic visits, intravitreal injections, and anxiety was higher after PnR. Hospitalizations and long-term disability were less frequent after PnR.
CONCLUSIONS
Pneumatic retinopexy, when compared with PPV, was associated with lower long-term health care costs. Pneumatic retinopexy appeared to be effective, safe, and inexpensive, thus offering a viable option for improving access to RRD repair in appropriately selected cases.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
目的
在全民医保体系下，全面比较气动视网膜固定术（PnR）与玻璃体切除术（PPV）治疗孔源性视网膜脱离（RRD）的成本效果、再附着率和并发症。
设计
基于人群的、多中心、连续的、回顾性纵向队列分析。
研究对象
我们确定了 2002 年 4 月 1 日至 2022 年 3 月 31 日期间，连续 20 年间≥50 岁的成年人，需要手术治疗原发性 RRD。初次手术被视为分析的索引日期。
干预
所有分析中，PnR 与 PPV 进行比较。
主要观察指标
主要分析比较了 PnR 与 PPV 在初次手术后 2 年内的平均年化医疗保健成本。次要分析检查了主要再附着率和并发症。
结果
共纳入 25665 名符合条件的患者，其中 8794 名患者接受 PnR，16871 名患者接受 PPV。患者平均年龄为 65 岁，39%为女性。PnR 后的平均年化费用为 8924 美元，PPV 后的费用为 11937 美元（平均差异 3013 美元；95%置信区间 2533-3493 美元；P<0.001）。PnR 后 90 天的主要再附着率为 83%，PPV 后为 93%（P<0.001）。PnR 后白内障或青光眼手术的风险较低，而 PnR 后眼科就诊、眼内注射和焦虑的频率较高。PnR 后住院和长期残疾的频率较低。
结论
与 PPV 相比，气动视网膜固定术的长期医疗保健费用较低。气动视网膜固定术似乎有效、安全且价格低廉，因此为在适当选择的病例中改善 RRD 修复的可及性提供了可行的选择。
财务披露
本文末尾的脚注和披露中可能包含专有或商业披露。
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