Factors associated with elevated rates of adverse outcomes after cyclodestructive procedures versus drainage device procedures

Objective: To identify factors associated with an increased risk of adverse outcomes after cyclodestructive or drainage device procedures. Design: Retrospective, cohort analysis. Participants: A total of 5570 Medicare patients who were older than 65 year s of age and who underwent cyclodestructive or drainage device procedures i n 1994 participated. Intervention: The authors identified cyclodestructive and drainage device p rocedures from claims to the Health Care Finance Administration (HCFA) by I nternational Classification of Diseases (ICD-9) procedure codes, Current Pr ocedural Terminology procedure codes, and HCFA Common Procedural Classifica tion System codes. The authors analyzed adverse outcome rates using hierarc hical logistic regression. Race, age group, gender, length of observed foll ow-up, state in which surgery took place, ocular procedures performed befor e and at the same time as the index surgery, and ocular diagnosis were incl uded as covariates in the model. Main Outcome Measures: The authors defined an adverse outcome as the occurr ence after the index surgery of at least one of the following: repeat cyclo destructive or drainage device procedure, retinal hole-tear repair, retinal detachment repair, surgery for endophthalmitis, vitrectomy, enucleation, e visceration, surgery for ocular hypotony, and/or extrusion or revision of d rainage device. Adverse outcomes were also defined without the inclusion of repeat cyclodestructive or drainage device procedures. Results: When repeat cyclodestructive or drainage device procedures were no t included in the definition of an adverse outcome, eyes with a drainage de vice procedure were 3.8 times more likely to have an adverse outcome than e yes with a cyclodestructive procedure (odds ratio [OR], 3.8; 95% confidence interval [CI], 3.07, 4.67). Subjects with concurrent corneal transplant ha d increased odds of an adverse outcome compared to subjects without a concu rrent corneal transplant (OR, 2.00; 95% CI, 1.27, 3.15). When the definitio n of an adverse outcome included repeat cyclodestructive or drainage device procedures, the odds of an adverse outcome were similar for both cyclodest ructive and drainage device procedures (OR, 0.94; 95% CI, 0.79, 1.13). Conclusions: Cyclodestructive procedures need to be repeated more frequentl y than drainage device procedures. However, if the patient has a drainage d evice procedure, then that patient is more likely to have other types of ad verse ophthalmic events than if he or she had a cyclodestructive procedure. Because the average follow-up of subjects in this study is 5 months (range , 0-12 months), outcomes that might take longer to manifest themselves woul d be excluded from this study.