Strabismus Surgery Reoperation Rates With Adjustable and Conventional Sutures

Abstract

Purpose To determine the association of strabismus surgery reoperation rates with adjustable or conventional sutures. Design Retrospective cross-sectional study. Methods Setting Review of a large national private insurance database. Study Population Adults age 18 to 89 having strabismus surgery between 2007 and 2011. Intervention Adjustable versus conventional suture strabismus surgery. Outcome Measure Reoperation rate in the first postoperative year. Results Overall, 526 of 6178 surgical patients had a reoperation (8.5%). Reoperations were performed after 8.1% of adjustable suture surgeries and after 8.6% of conventional suture surgeries (p=0.57). Of the 4357 horizontal muscle surgeries, reoperations were performed after 5.8% of adjustable suture surgeries, and after 7.8% of conventional suture surgeries (p=0.02). Of the 1072 vertical muscle surgeries, reoperations were performed after 15.2% of adjustable suture surgeries, and after 10.4% of conventional suture surgeries (p=0.05). Younger age (18 to 39 years) was associated with a lower reoperation rate (p ≤ 0.02). The significant multivariable predictors of reoperation for horizontal surgery were adjustable sutures (odds ratio, OR 0.69, 95% confidence interval 0.52 to 0.91), monocular deviation (OR 0.64), complex surgery (OR 1.63), and unilateral surgery on two horizontal muscles (OR 0.70, all p ≤ 0.01). Adjustable sutures were not significantly associated with reoperation rates after vertical muscle surgery (multivariable OR 1.45, p=0.07). Conclusions Adjustable sutures were associated with significantly fewer reoperations for horizontal muscle surgery. Adjustable sutures tended to be associated with more reoperations for vertical muscle surgery, but this observation was not statistically significant in the primary analysis after controlling for age.

Rates of Reoperation and Abnormal Binocularity Following Strabismus Surgery in Children

“…We counted either horizontal or vertical procedures as reoperations, as done previously. 4 In the present study, any additional incisional strabismus surgery or botulinum injection within the first year counted as a reoperation. All of these procedures usually involve general anesthesia in children.…”

“…22 These databases have been used to report various ophthalmic treatment outcomes, 23,24 including strabismus surgery reoperation in adults. 4 …”

“…The following strabismus types were defined as previously: complex, incomitant, paralytic, alternating, A or V pattern, mechanical, intermittent. 4 As previously, monocular deviation was defined as ICD 378.01–378.04, 378.11–378.14, or 378.34. 4 Diagnosis codes for refractive error (e.g.…”

“…4 As previously, monocular deviation was defined as ICD 378.01–378.04, 378.11–378.14, or 378.34. 4 Diagnosis codes for refractive error (e.g. hyperopia, ICD 367.0, and regular astigmatism 367.21) and abnormal binocularity were identified in the claims record, which included office visits, in the two years prior to surgery (Table 1).…”

“…2 Similarly, whether to operate on two, or more than two, muscles in large angle esotropia is not well-defined. 3 In addition, for exotropia, unilateral two-muscle surgery has been found to have a lower reoperation rate than bilateral single-muscle surgery in a retrospective review of adult surgery 4 and in randomized trials which included primarily children. 5,6 …”