Chen Darren A, Azad Amee D, Lin Lisa Y, Yoon Michael K
Department of Ophthalmology, Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A.
Ophthalmic Plast Reconstr Surg. 2025;41(3):315-319. doi: 10.1097/IOP.0000000000002836. Epub 2024 Dec 10.
The purpose of this study is to assess the surgical costs of enucleations and eviscerations and their relation to current reimbursement rates using time-driven activity-based costing.
This is a retrospective study of patients undergoing enucleation and evisceration surgeries with attachment of muscles (Current Procedural Terminology 65105 and 65093) for a diagnosis of blind, painful eye, from January 1, 2019, to December 31, 2023, at a single, tertiary level, teaching hospital. A time-driven activity-based cost analysis for day of surgery was performed. Operative reports, perioperative times, and supply costs were extracted from the electronic medical record, and average reimbursement fees were taken from Center for Medicare and Medicaid Services data.
In the 5-year study span, 110 patients underwent enucleation and 52 underwent evisceration for a primary indication of blind, painful eye by 10 different surgeons. The average operating room time and surgical time for enucleation was approximately 9 minutes longer compared with evisceration ( p < 0.01). Both surgeries on average resulted in a negative margin with enucleations costing on average $624 more than eviscerations. The breakeven total operating room time for enucleation and evisceration surgery was approximately 86.3 and 83.1 minutes, respectively. From the sample, approximately 79% of enucleation and 60% of evisceration surgeries resulted in a net negative margin.
On average, the cost of enucleation and evisceration surgeries exceeded the reimbursement amount set by the Center for Medicare and Medicaid Services. Compared with enucleation, evisceration was more time and cost-effective by only a modest margin.
本研究旨在使用时间驱动作业成本法评估眼球摘除术和眼内容剜出术的手术成本及其与当前报销率的关系。
这是一项对2019年1月1日至2023年12月31日期间在一家单一的三级教学医院因诊断为盲痛眼而接受眼球摘除术和眼内容剜出术并附着肌肉（当前程序编码65105和65093）的患者进行的回顾性研究。对手术日进行了时间驱动作业成本分析。从电子病历中提取手术报告、围手术期时间和耗材成本，并从医疗保险和医疗补助服务中心的数据中获取平均报销费用。
在5年的研究期间，10位不同的外科医生为110例患者进行了眼球摘除术，52例患者进行了眼内容剜出术，主要指征为盲痛眼。与眼内容剜出术相比，眼球摘除术的平均手术室时间和手术时间大约长9分钟（p < 0.01）。两种手术平均均产生了负利润，眼球摘除术的平均成本比眼内容剜出术高624美元。眼球摘除术和眼内容剜出术的盈亏平衡总手术室时间分别约为86.3分钟和83.1分钟。在样本中，大约79%的眼球摘除术和60%的眼内容剜出术产生了净负利润。
平均而言，眼球摘除术和眼内容剜出术的成本超过了医疗保险和医疗补助服务中心设定的报销金额。与眼球摘除术相比，眼内容剜出术在时间和成本效益上仅略占优势。
