2016 年至 2019 年 Medicare 人群青光眼手术后早期眼内炎的发病率及危险因素。

Early Endophthalmitis Incidence and Risk Factors after Glaucoma Surgery in the Medicare Population from 2016 to 2019.

机构信息

Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Biomedical Informatics and Data Science, Johns Hopkins University School of Medicine, Baltimore, Maryland.

出版信息

Ophthalmology. 2024 Feb;131(2):179-187. doi: 10.1016/j.ophtha.2023.09.008. Epub 2023 Sep 12.

DOI:10.1016/j.ophtha.2023.09.008

PMID:37709170

Abstract

PURPOSE

To determine early endophthalmitis incidence and risk factors after glaucoma surgeries in the Medicare population.

DESIGN

Retrospective, longitudinal study.

PARTICIPANTS

Medicare Fee-for-Service (FFS) and Medicare Advantage beneficiaries in the United States aged 65 years or older undergoing glaucoma surgery.

METHODS

Medicare claims were used to identify all patients who underwent glaucoma, cataract, or combined cataract/glaucoma surgery from 2016 to 2019. Endophthalmitis cases within 42 days of the index surgery were identified using the diagnostic codes. Multivariable logistic regression models were used to evaluate factors associated with postoperative endophthalmitis.

MAIN OUTCOME MEASURES

The 42-day postoperative endophthalmitis incidence and risk factors associated with endophthalmitis after glaucoma surgery.

RESULTS

There were 466 928 glaucoma surgeries, of which 310 823 (66.6%) were combined with cataract surgery. Cataract surgeries alone (n = 8 460 360) served as a reference group. Microinvasive glaucoma surgeries constituted most glaucoma procedures performed (67.8%), followed by trabeculectomy (14.0%), tube shunt (10.9%), and other procedures (7.3%). There were 572 cases of endophthalmitis identified after all glaucoma surgeries. Endophthalmitis incidence after glaucoma, combined cataract/glaucoma, and cataract surgeries alone was 1.5 (95% confidence interval [CI], 1.3-1.7), 1.1 (95% CI, 1.0-1.2), and 0.8 (95% CI, 0.8-0.8) per 1000 procedures, respectively. The median day of diagnosis of endophthalmitis was later for glaucoma surgeries (16.5 days) compared with combined cataract/glaucoma or cataract surgeries alone (8 and 6 days, respectively). Compared with microinvasive glaucoma surgery (MIGS), tube shunts were the only surgery type to be a significant risk factor for endophthalmitis for both stand-alone (adjusted odds ratio [aOR], 1.8, P = 0.002) and combined surgery (aOR 1.8, P = 0.047). The other risk factor for both stand-alone (aOR 1.1, P = 0.001) and combined (aOR 1.06, P = 0.049) surgeries was the Charlson Comorbidity Index (CCI). Age (aOR 1.03, P = 0.004) and male gender (1.46, P = 0.001) were significant risk factors for combined cataract and glaucoma surgeries.

CONCLUSIONS

Compared with cataract surgery, early endophthalmitis incidence was higher for both glaucoma and combined cataract/glaucoma surgeries, with the highest incidence among tube shunts.

FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

摘要

目的

确定 Medicare 人群青光眼手术后早期眼内炎的发病率和相关风险因素。

设计

回顾性、纵向研究。

参与者

在美国，年龄在 65 岁及以上，接受青光眼手术的 Medicare 收费服务（FFS）和 Medicare 优势计划的患者。

方法

使用 Medicare 理赔数据确定 2016 年至 2019 年期间接受青光眼、白内障或联合白内障/青光眼手术的所有患者。通过诊断代码确定索引手术后 42 天内的眼内炎病例。使用多变量逻辑回归模型评估与青光眼手术后眼内炎相关的因素。

主要观察指标

术后 42 天的眼内炎发生率以及与青光眼手术后眼内炎相关的风险因素。

结果

共进行了 466928 例青光眼手术，其中 310823 例（66.6%）联合白内障手术。单纯白内障手术（n=8460360）作为参照组。微创青光眼手术是最常见的青光眼手术方式（67.8%），其次是小梁切除术（14.0%）、引流管分流术（10.9%）和其他手术（7.3%）。所有青光眼手术后共发现 572 例眼内炎病例。青光眼、联合白内障/青光眼和单纯白内障手术后的眼内炎发生率分别为 1.5（95%置信区间[CI]，1.3-1.7）、1.1（95%CI，1.0-1.2）和 0.8（95%CI，0.8-0.8）/1000 例。与联合白内障/青光眼或白内障手术相比，青光眼手术中眼内炎确诊的中位天数（16.5 天）较晚（分别为 8 天和 6 天）。与微创青光眼手术（MIGS）相比，引流管分流术是单纯手术（校正比值比[aOR]，1.8，P=0.002）和联合手术（aOR，1.8，P=0.047）中唯一的手术类型，是眼内炎的显著风险因素。单纯手术（aOR，1.1，P=0.001）和联合手术（aOR，1.06，P=0.049）的另一个风险因素是 Charlson 合并症指数（CCI）。年龄（aOR，1.03，P=0.004）和男性（1.46，P=0.001）是联合白内障和青光眼手术的显著风险因素。