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Duna Raoof-Daneshvar, Roni Shtein, Taylor Blachley, Maria Woodward, Shahzad Mian, Alan Sugar, Joshua Stein; Comparison of Resource Consumption in Penetrating versus Endothelial Keratoplasty from 2009-2010. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4389.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate differences in resource consumption associated with postoperative management of patients in a large nationwide U.S. managed care network who underwent penetrating keratoplasty (PK) or endothelial keratoplasty (EK) for corneal endothelial disease (CED).
All individuals age ≥ 50 years with CED who underwent ≥ 1 keratoplasty surgery between January 2009 and December 2010 and had at least 1 year of follow-up were identified from a large managed care network database. Numbers of billed post-operative visits to eye-care providers, diagnostic procedures (e.g., topography, specular microscopy), and need for concomitant or subsequent intraocular surgery were obtained from the billing data. Statistical comparisons of resource utilization between PK and EK were performed.
A total of 115 PK and 194 EK surgeries were performed for CED during 2009-2010. The mean number of billed post-operative visits to eye-care providers in the year after surgery was higher for PK compared with EK (5.9 ± 4.5 for PK versus 3.4 ± 2.8 for EK) (p< 0.0001). The mean number of anterior segment diagnostic tests performed in the year after surgery was also higher for PK compared with EK (1.4 ± 2.0 for PK vs. and 0.7 ± 1.2 for EK) (p= 0.0007). Among the 115 enrollees who underwent PK, cataract surgery was performed concurrently in 12.1% and in the year following surgery in 4.3%. By comparison, among the 194 enrollees who underwent EK, cataract surgery was performed concurrently in 38.7% and in the year following surgery in an additional 22.2%. The rate of serious complications for both of these surgeries was low and not significantly different between EK and PK (p=0.29).
Numbers of post-operative visits and diagnostic testing in the year after surgery were much less for enrollees undergoing EK as compared with PK. However, there were considerably more cataract surgeries performed both concurrently and in the year following surgery with EK as compared with PK (60.9% v. 16.4%). Improved understanding of resource consumption associated with PK and EK can help inform future analyses of costs as well as patient and caregiver burden associated with these procedures.
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