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Kristen Nwanyanwu, Joshua Warren; Risk factors associated with complex vitreoretinal surgery for patients with diabetes.. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1037.
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© ARVO (1962-2015); The Authors (2016-present)
Retinal surgery causes a significant amount of morbidity in patients with diabetes mellitus (DM). We performed a comparative cohort study to identify factors associated with complex surgery for patients with DM at a tertiary referral academic center.
Electronic medical records were evaluated from 2013-2016. Individuals included in the database had a diagnosis of DM based on ICD-9-CM billing codes 250.xx or ICD-10-CM billing codes E10.X or E11.X. Patients who underwent routine vitreoretinal surgery (CPT codes 67036 or 67040) and patients who underwent complex surgery (CPT code 67113) were identified. Statistical analyses were summarized using means and standard deviations for continuous variables and frequencies and percentages for categorical variables. A mixed effects logistic regression model was used to determine the factors associated with requiring complex surgery and to evaluate geospatial differences between populations based on residential ZIP codes. For all analyses, P<0.05 was considered statistically significant.
Of the 347 procedures,164 were complex and 132 were performed on females. The mean age of routine vitrectomy patients was 57.6 years and 63.2 years for complex vitrectomy patients (p = 0.0002). Black patients accounted for 39.2% complex vitrectomies, but only 25% of routine vitrectomies. White patients made up 42% of complex vitrectomy and 49% of routine vitrectomies (p = 0.01). After adjustment for age, gender, race, ethnicity, HbA1c, and ZIP code of residence (random effect), increasing age by a single year was associated with a 3 % increased odds of undergoing routine vitrectomy [1.03, 95% CI 1.01,1.04]. Race approached statistical significance. In patients identified as Other race, routine vitrectomy was more likely than in Black patients [2.30, 95% CI 0.99, 5.31]. Other factors were not statistically significant.
We identified increased age as a factor that is independently associated with undergoing routine vitrectomy over complex vitrectomy. While statistically significant larger percentage of patients in the complex vitrectomy group were Black, when controlling for other factors, race did not reach statistical significance. HbA1c does not appear to be associated with the need for complex vitrectomy in patients with DM.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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