Bartamian M, Meyer D R
Division of Oculoplastic and Orbital Surgery, Lions Eye Institute, Albany, NY 12208, USA.
Ophthalmology. 1996 Oct;103(10):1628-33. doi: 10.1016/s0161-6420(96)30453-3.
Variations in physician practice patterns, particularly with reference to cost-intensive resource utilization, are increasingly being scrutinized. However, little information is currently available regarding physician practice patterns for oculoplastic surgery.
The authors surveyed members of the American Society of Ophthalmic Plastic and Reconstructive Surgery regarding their most common site of service, type of anesthesia, and first postoperative week of follow-up for 15 selected eyelid, lacrimal, and orbital procedures.
The majority of eyelid and lacrimal surgeries are currently performed on an out-patient basis (hospital out-patient, ambulatory surgery center, or office), typically using local anesthesia, with or without sedation. Regional differences were noted. Physicians in western states showed a greater tendency toward office-based surgery for procedures such as blepharoplasty and ptosis repair. Orbital procedures were performed more frequently as a hospital inpatient surgery, under general anesthesia. Patterns of follow-up within the first postoperative week varied considerably for most procedures. Compared with admitting practices in 1987, an obvious trend toward out-patient surgery was noted.
Variations in practice patterns will assume greater importance as the pressure for cost-containment increases. Total costs are affected by physician choices for site of service and type of anesthesia. This study allows surgeons who perform oculoplastic procedures to compare their practices with a national group specializing in such surgery. Further outcome-oriented studies are needed to develop practice guidelines for "preferred patterns" of care.
医生的执业模式差异，尤其是在成本密集型资源利用方面，正受到越来越多的审视。然而，目前关于眼部整形手术医生执业模式的信息很少。
作者对美国眼科整形与重建外科学会的成员进行了调查，询问他们在15种选定的眼睑、泪道和眼眶手术中最常见的手术地点、麻醉类型以及术后第一周的随访情况。
目前大多数眼睑和泪道手术是在门诊进行（医院门诊、门诊手术中心或办公室），通常采用局部麻醉，可加或不加镇静剂。存在地区差异。西部各州的医生在进行眼睑整形术和上睑下垂修复等手术时，更倾向于在办公室进行手术。眼眶手术作为住院手术在全身麻醉下进行的频率更高。大多数手术术后第一周的随访模式差异很大。与1987年的收治情况相比，门诊手术有明显的趋势。
随着成本控制压力的增加，执业模式的差异将变得更加重要。总成本受医生对手术地点和麻醉类型的选择影响。这项研究使进行眼部整形手术的外科医生能够将自己的执业情况与专门从事此类手术的全国性群体进行比较。需要进一步开展以结果为导向的研究，以制定“首选模式”护理的执业指南。
