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S. Day, D. S. Grossman, F. A. Sloan, P. P. Lee; One Year Outcomes After Retinal Detachment Surgery. Invest. Ophthalmol. Vis. Sci. 2010;51(13):6064.
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To determine longitudinal rates of second operation and postoperative adverse outcomes after retinal detachment surgery in a nationally representative sample of older Americans.
Using Medicare 5% inpatient, outpatient, Part-B, and durable medical equipment claims files, we identified beneficiaries who were diagnosed with rhegmatogenous retinal detachment (RRD) between 1991-2007 who underwent primary pars plana vitrectomy (PPV), scleral buckle (SB), combined pars plana vitrectomy and scleral buckle (PPV/SB), pneumatic retinopexy (PR), or laser photocoagulation or cryotherapy alone. RRD, PPV, SB, combined PPV/SB, PR, and laser photocoagulation/cryotherapy were ascertained from International Classification of Diseases (ICD-9-CM) and Current Procedural Terminology (CPT) procedure codes. Rates of second operation and postoperative adverse outcomes were analyzed by cumulative incidence and logistic regression to control for prior adverse outcome measures and demographic factors.
In a 5% random sample of Medicare beneficiaries between 1991-2007, there were 10,292 beneficiaries who underwent repair of RRD. At 1-year follow-up, the rate of receipt of another operation among Medicare beneficiaries who had undergone primary PR was much higher (40.5%) relative to the PPV (20.9%) and SB (19.2%) groups. PR individuals were more than 3 times as likely, while PPV/SB individuals were 75% more likely, and PPV individuals were 22% more likely to receive another retinal repair procedure compared to laser/cryotherapy individuals. Individuals receiving PPV had the highest rate of adverse outcomes (3.8%), and were nearly 3 times as likely to suffer adverse outcomes than were persons undergoing laser/cryotherapy alone. Results were robust in sensitivity analysis. Rates did not differ by cohort group.
The rate of second operation was much higher after PR than PPV or SB, and the rate of adverse outcomes was higher in PPV, even after controlling for risk factors and demographic variables.
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