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.