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Natalia F. Callaway, Daniel Vail, Suzann Pershing, Cassie A. Ludwig, Darius Moshfeghi; Gender Differences in Surgical Intervention Rate and Timing for Rhegmatogenous Retinal Detachments Among US Commercially Insured Patients From 2007-2015. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6568.
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Rhegmatogenous retinal detachment (RRD) is a vision-threatening condition that requires urgent surgical intervention to optimize visual outcomes. There is limited data on sex differences in the diagnosis and treatment of RRD although studies in other surgical subspecialties report lower surgical intervention rates for women. The purpose of this study is to describe the rate and time to RRD repair by sex. We hypothesize that women have lower rates of RRD repair and that surgical intervention is delayed compared to men.
A retrospective cohort study using the Truven Health MarketScan Research Databases, which contain administrative data for beneficiaries from a wide variety of private payers, from 2007 to 2015. The dataset represents roughly 50% of the U.S. population covered by employer-sponsored insurance. Records for beneficiaries with a primary RRD diagnosis and at least one year of longitudinal data were analyzed by sex, surgical intervention, and time to intervention. Surgical intervention was identified by procedure codes for pneumatic retinopexy, pars plana vitrectomy, or scleral buckle after RRD ICD9 coding in the same eye. Records were then reviewed for repeat retinal surgery within three months for recurrent detachment. Patients without documentation of a laterality modifier were excluded.
We identified 21,807 RRD patients with laterality documentation: 9,600 women (44%) and 12,207 men (56%). Any surgical intervention occurred in 11,513 (53%). There was a statistically significant gender difference in the rate of surgical intervention for RRD with 48% (n=4,567) of women receiving any surgery compared to 57% (n=6,946) men (p=<0.0001). The time from diagnosis to surgical intervention is longer for women compared to men (Figure 1, p=<0.0001). Among patients who receive RRD surgical intervention 59% (n=6,807) received repeat surgical intervention within three months. There was no significant difference in the rate (60% women, 59% men) or time to secondary surgical intervention (p=0.12).
Among patients in a broadly representative commercial claims database women were less likely to receive surgical intervention for RRD and that intervention was more often delayed compared with their male counterparts. The reason for this gender difference remains poorly understood and requires further investigation.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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