Surgeon Volume and Success Rate in Primary Rhegmatogenous Retinal Detachment.

Purpose

Evaluate the incidence and predictors of primary rhegmatogenous retinal detachment (RD) revision among Medicare beneficiaries.

Methods

We included adult patients undergoing RD repair using scleral buckle and/or vitrectomy. We extracted patient demographics and information pertaining to the RD (using ICD-10 modifiers) and surgical repair (using CPT codes). Surgeon-level factors included the surgeon volume of RD in the dataset, surgeon graduation year, practice volume and setting (teaching vs not and urban vs rural). Surgeon volume was categorized as: 10-25 surgeries, 26-50 surgeries and > 50 surgeries. RD revision was defined as repeat surgery or pneumatic retinopexy in the same eye within 2 years.

Results

25,456 surgeries were included. Average age was 70.4 ± 8.3 and 9,105 (35.8%) were female. Revision was needed in 3,649 (14.3%). The median time to RD revision was 73 days. The main predictors of RD revision were GRT (RR=1.39; 95% CI=1.13-1.72), total RD (RR=1.30; 95% CI=1.15-1.47), and complex vitrectomy +/- buckle (RR=1.29; 95% CI=1.09-1.53).

Conclusions

RD revision was needed in 14.3%. The main factors associated with increased risk of RD revision were the need for complex vitrectomy, GRT and total RD. Surgeon and practice volumes were not significant predictors.