Variation between surgeons in rate of reoperation after horizontal strabismus surgery among Medicare beneficiaries: associations with patient and surgeon characteristics and adjustable sutures.

Christopher T Leffler, Alicia Woock, Meagan Shinbashi, Melissa Suggs
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Abstract

Objective: To quantify variation between surgeons in reoperation rates after horizontal strabismus surgery, and to explore associations of reoperation rate with surgical techniques, patient characteristics, and practice type and volume. Methods: Fee-for-service payments in a national database to providers for Medicare beneficiaries having strabismus surgery on horizontal muscles between 2012 and 2020 were analyzed retrospectively to identify same calendar year reoperations. Multivariable linear regression was used to determine predictors of each surgeon's reoperation rate. Results: The reoperation rate for 1-horizontal muscle surgery varied between 0.0% and 30.8% among 141 surgeons. Just 7.8% of surgeons contributed over half of the reoperation events for 1-horizontal muscle surgery, due to the presence of high-volume surgeons with high reoperation rates. Surgeon seniority, gender, surgery volume, and use of adjustable sutures were not independently associated with surgeon reoperation rate. We explored associations of reoperation with patient characteristics, such as age and poverty. Surgeons in the South tended to have a higher reoperation rate (p=0.03) in a multivariable model. However, the multivariable model could only explain 16.3% of the inter-surgeon variation in reoperation rate for 1-horizontal muscle surgery. Discussion: Strabismus surgery is similar to other areas of medicine, in which large variations in outcomes between surgeons are observed. Future work can be directed towards explaining this variation. Conclusions: Patient-level analyses that fail to consider variation between surgeons will be dominated by a small number of high-reoperation, high-volume surgeons. Order-of-magnitude variations exist in reoperation rates among strabismus surgeons, the cause of which is largely unexplained.

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医疗保险受益人接受水平斜视手术后再次手术率在不同外科医生之间的差异:与患者和外科医生特征及可调节缝合线的关系。
目的量化不同外科医生水平斜视手术后再手术率的差异,并探讨再手术率与手术技术、患者特征、诊疗类型和数量之间的关联。研究方法回顾性分析全国数据库中医疗保险受益人在 2012 年至 2020 年期间接受水平肌斜视手术的医疗服务费支付情况,以确定同一日历年的再手术情况。采用多变量线性回归确定每位外科医生再手术率的预测因素。结果在 141 名外科医生中,1-横纹肌手术的再手术率介于 0.0% 和 30.8% 之间。仅有7.8%的外科医生造成了超过一半的1-横纹肌手术再手术事件,这是因为存在高再手术率的高产量外科医生。外科医生的资历、性别、手术量和可调节缝合线的使用与外科医生的再手术率并无独立关联。我们探讨了再手术与患者特征(如年龄和贫困)的关系。在多变量模型中,南方的外科医生往往有更高的再手术率(P=0.03)。然而,多变量模型只能解释 16.3% 的单横纹肌手术再手术率的医生间差异。讨论:斜视手术与其他医学领域类似,不同外科医生的手术结果存在很大差异。今后的工作可致力于解释这种差异。结论:未考虑外科医生之间差异的患者层面分析将被少数高手术量、高手术量的外科医生所主导。斜视外科医生之间的再手术率存在数量级的差异,其原因在很大程度上尚未得到解释。
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