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美国白内障手术门诊手术中心使用趋势,2001-2014

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

期刊名称:JAMA Ophthalmology

卷期:2018年第136卷第1期

摘要

摘要:重要性:白内障手术通常在门诊手术中心(ASCs)和医院门诊部(HOPDs)进行。这些场所在许多方面都有不同,包括手术效率、病人的吞吐量、病人的安全、以及每个手术的费用。

目的:确定从2001年到2014年在门诊手术中心(ASCs)和医院门诊部(HOPDs)进行白内障手术的应用趋势,以及影响手术进行场所的因素。

设计、设置和参与者:这一回顾性纵向队列分析涉及到在20011月至201412月期间美国国家管理关怀网络的帮助下接受白内障手术的40岁及以上的个体。数据分析是从20162月到20172月。

主要结果和措施:我们找到以上所有接受白内障手术的注册者,并确定了其手术是在ASC还是HOPD进行的。我们计算了从2001年到2014年每年在每个地点的手术比例。利用多变量逻辑回归确定了在ASCHOPD进行白内障手术的个体的特征。我们还评估了白内障手术在全美306个社区占比的地理性变化。

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%

结论与相关性:我们观察到从2001年到2014年,进行白内障手术的场所发生了很大的变化:从医院门诊部(HOPDs)到门诊手术中心(ASC)。未来的研究需要评估这一转变在外科手术治疗现场的效果,包括病人手术的可及性、手术结果、病人安全以及社会成本。

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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