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Stagg, B.C., Talwar, N., Mattox, C., Lee, P.P., Stein, J.D.

期刊名称:JAMA Ophthalmology







结果:本研究纳入369320名注册者中,女性为208319(56.4%),平均年龄为66.3(SD10.4)。从2001年到2014年,所有的注册者都接受了白内障手术(53325例手术)。其中,237 046(64.2%)在门诊手术中心(ASC)进行了白内障手术。在门诊手术中心(ASCs)进行白内障手术的比例从2001年的43.6%上升到2014年的73.0%。与收入低于4万美元的注册者相比,收入超过10万美元的人在门诊手术中心(ASC)中接受白内障手术的可能性要高出20%(优势比为1.20;95%可信区间,1.12 -1.29)。总体健康状况良好的参保者相比医院门诊部(HOPDs)不太可能在门诊手术中心(ASC)(优势比为1.00;95%可信区间,0.99-1.00)进行白内障手术。在不需要法律证明的社区中居住的注册者,门诊手术中心(ASC)(优势比,2.49;95%可信区间,2.35 - -2.63)做手术的几率是其他不需要法律证明的两倍多。从2012年到2014年,在ASCs进行白内障手术的比例差别很大,从威斯康星州的拉克罗斯(La Crosse)1.6%,到科罗拉多州普韦布洛(Pueblo)98.8%


Importance:Cataract surgery is commonly performed at ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs). These venues differ in many ways, including surgical efficiency, patient throughput, patient safety, and costs per surgery.Objective:To determine trends in use of ASCs and HOPDs for cataract surgery from 2001 to 2014 and factors affecting the site of surgery.Design, Setting, and Participants:This retrospective longitudinal cohort analysis involved individuals 40 years and older who underwent cataract surgery between January 2001 and December 2014 from a nationwide US managed care network. Data were analyzed from February 2016 to February 2017.Main Outcomes and Measures:We identified all enrollees who underwent cataract surgery and determined whether the surgery was performed at an ASC or HOPD. We calculated the proportion of surgeries performed at each site each year from 2001 to 2014. Multivariable logistic regression identified characteristics of enrollees who had cataract surgery at an ASC vs a HOPD. We also assessed geographic variation in the proportion of cataract surgeries performed at ASCs in 306 communities throughout the United States.Results:Of the 369  320 enrollees included in this study, 208  319 (56.4%) were female, and the mean (SD) age was 66.3 (10.4) years. All enrollees underwent cataract surgery (531  325 surgeries) from 2001 to 2014. Of these, 237  046 (64.2%) underwent cataract surgery at an ASC. The proportion of cataract surgeries performed at ASCs increased from 43.6% in 2001 to 73.0% in 2014. Compared with enrollees with incomes less than $40  000, those with incomes greater than $100  000 were 20% more likely to undergo cataract surgery at an ASC (odds ratio, 1.20; 95% CI, 1.12-1.29). Enrollees with better overall health were no more likely to undergo cataract surgery at an ASC (odds ratio,  1.00; 95% CI, 0.99-1.00) than at an HOPD. Enrollees who lived in communities without certificate of need laws were more than twice as likely to have surgery at an ASC (odds ratio,  2.49; 95% CI, 2.35-2.63). The proportion of cataract surgeries performed at ASCs from 2012 to 2014 varied considerably, from 1.6% in La Crosse, Wisconsin, to 98.8% in Pueblo, Colorado.Conclusions and Relevance:We observed a large shift in the site of cataract surgery from HOPDs to ASCs from 2001 to 2014. Future research is needed to assess the effect of this transition in site of surgical care on patient access to surgery, surgical outcomes, patient safety, and societal costs.


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