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Orbital Complications and Cost Analysis of Enucleation by Myoconjunctival versus Conventional Techniques for Retinoblastoma. 眼眶并发症和视网膜母细胞瘤肌结膜去核术与传统技术的成本分析

IF 1 4区教育学 Q4 EDUCATION, SCIENTIFIC DISCIPLINES

Physics Teacher

Pub Date : 2023-12-01 Epub Date: 2023-07-20 DOI: 10.1159/000531871

Leonardo Lando, Ashwin Mallipatna, Stephanie N Kletke, Brenda Gallie

Introduction: The aim of the study was to compare complication rates and hospital costs of myoconjunctival versus conventional enucleation techniques in retinoblastoma.

Methods: This retrospective cohort and cost analysis reviewed patients with retinoblastoma treated by primary or secondary enucleation between 2003 and 2021 and a minimum 6-month follow-up. Cases were reviewed for three postsurgical complications: chronic conjunctivitis, implant exposure/extrusion, and cellulitis. Cases were excluded if surgery was performed elsewhere or documentation was incomplete. Treatment costs were estimated based on two sample cases billed in 2021 that manifested the studied complications and represented each of the two surgical techniques. Univariate and multivariate analyses were applied to compare complication rates and treatment costs.

Results: Included were 180 eyes (179 patients); 239 eyes (227 patients) were excluded. Patients had median age of 18.9 (0-104.4) months at diagnosis, the majority were male (94, 52%), with unilateral (115, 64%) group D or E (163, 91%) eyes. Enucleation was performed by conventional techniques in 107 eyes (59%) and by myoconjunctival approach in 73 (41%). Orbital complications occurred in 61 eyes (34%) during a median follow-up of 7.9 (0.5-33.7) years, more frequently in the conventional technique group (p = 0.014). The myoconjunctival technique had significantly lower costs for implant price (p < 0.001) and estimated treatment cost, including complication management (p < 0.001).

Conclusion: Enucleation by myoconjunctival technique showed significantly less complication burden and treatment cost, indicating advantages over conventional approaches. Study limitations include the retrospective nature, confounders' complexity, and follow-up time variations.

简介该研究旨在比较肌结膜和传统去核技术治疗视网膜母细胞瘤的并发症发生率和住院费用：这项回顾性队列和成本分析回顾了 2003 年至 2021 年间接受原发性或继发性去核术治疗的视网膜母细胞瘤患者，并进行了至少 6 个月的随访。对病例的三种术后并发症进行了审查：慢性结膜炎、植入物暴露/挤出和蜂窝组织炎。如果手术在其他地方进行或记录不完整，则排除病例。根据 2021 年的两例样本病例估算了治疗费用，这两例病例均出现了所研究的并发症，并分别代表了两种手术技术。采用单变量和多变量分析比较并发症发生率和治疗费用：共纳入 180 只眼睛（179 名患者）；排除 239 只眼睛（227 名患者）。患者确诊时的中位年龄为18.9（0-104.4）个月，大多数为男性（94，52%），单侧（115，64%）D组或E组（163，91%）眼。107只眼睛（59%）通过常规技术进行了去核手术，73只眼睛（41%）通过肌结膜方法进行了去核手术。在中位 7.9 (0.5-33.7) 年的随访期间，有 61 只眼睛（34%）出现眼眶并发症，其中传统技术组更常见（p = 0.014）。肌结膜技术的植入物价格（p < 0.001）和包括并发症处理在内的估计治疗费用（p < 0.001）均明显较低：结论：采用肌结膜技术进行去核手术的并发症负担和治疗成本明显较低，显示出其优于传统方法。研究的局限性包括回顾性、混杂因素的复杂性和随访时间的变化。

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Comments on: Alternative exit sites for central venous access: Back tunneling to the scapular region and distal tunneling to the patellar region. 评论：中心静脉通路的替代出口部位：肩胛区背部隧道和髌骨区远端隧道。

4区教育学 Q4 EDUCATION, SCIENTIFIC DISCIPLINES

Physics Teacher

Pub Date : 2023-11-01 Epub Date: 2022-04-08 DOI: 10.1177/11297298221087886

Shun Yoshida, Manabu Haneda