Abstract
Concern over cost of health care has resulted in a call for meaningful outcome metrics. We describe a novel, goal-determined, risk-stratified (GDRS) outcomes analysis tool applicable to strabismus surgery, and utilize it to report our results in esotropia surgery. A GDRS outcomes analysis tool was applied to all patients undergoing esotropia surgery between 2006 and early 2011 at Children's Hospital Boston. One of four primary goals was assigned to each case: binocular potential; restoration of eye contact; diplopia control; or torticollis management. Pre- and postoperative alignment, fusion, age, alphabet patterns, accommodative status, and use of adjustable sutures were documented, as were potential ocular and systemic risk factors. Criteria for success were linked to the primary goal. A total of 733 patients underwent surgery for esotropia performed by 14 attending surgeons. Ocular or systemic risk factors were present in 376 (51%). Of these, 170 (45%) had prior strabismus surgery. 349 procedures were performed to improve binocular potential, 220 to restore eye contact, 121 to resolve diplopia and 43 to remediate torticollis. Excellent (70.4%) or good (13.8%) results were obtained in 84.2% of patients. The primary surgical goal did not influence success rates. Patients with ocular or systemic risk factors had significantly lower success rates (P = 0.036), most certainly in those with prior strabismus surgery (P = 0.004). In contrast, better outcomes were obtained in patients without associated risk factors (P = 0.032). Within the binocular potential cohort, patients with partially accommodative esotropia showed better outcomes (P = 0.038). GDRS analysis provides meaningful stratification of patients undergoing strabismus surgery allowing for clinically relevant measurements of outcomes.
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
