PURPOSE

To examine risk factors for strabismus surgery reoperation in patients with thyroid eye disease (TED).

DESIGN

Retrospective cohort study.

METHODS

An insurance claims database was used to identify patients with TED who underwent at least one strabismus operation between 2003 and 2019. We recorded specific muscles operated on, as well as the timing and frequency of reoperations. Cox regressions were used to estimate associations between time to reoperation and patient and primary surgery characteristics.

RESULTS

Of the 448 patients who met inclusion criteria, 111 (24.8%) underwent a reoperation. Patients were followed for an average of 5.4 ± 3.0 years after their initial strabismus surgery. The rates of reoperation among patients whose initial surgery involved horizontal muscles only, vertical muscles only, and horizontal and vertical muscles were 29 of 120 (24.2%), 33 of 169 (19.5%), and 49 of 159 (30.8%) respectively (P = .05). The number of muscles operated on initially was the only independent predictor for undergoing a strabismus surgery reoperation (odds ratio, 1.27; 95% confidence interval, 1.03–1.57; P = .03). The number of muscles operated on initially was also associated with shorter time to first reoperation (hazard ratio, 1.22; 95% confidence interval, 1.02–1.46; P = .03). Age at first surgery, time between diagnosis of TED and first strabismus surgery, gender, race, and use of adjustable sutures were not associated with time to reoperation.

CONCLUSIONS

Approximately 1 in 4 patients with TED require reoperation after strabismus surgery. The number of muscles operated on was the only independent predictor for both undergoing a reoperation and time to first reoperation.

中文翻译：

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甲状腺眼病患者斜视手术后再次手术的危险因素

目的

检查甲状腺眼病（TED）患者斜视手术再次手术的危险因素。

设计

回顾性队列研究。

方法

使用保险索赔数据库来识别 2003 年至 2019 年间至少接受过一次斜视手术的 TED 患者。我们记录了接受手术的特定肌肉以及再次手术的时间和频率。Cox 回归用于估计再手术时间与患者和初次手术特征之间的关联。

结果

在 448 名符合纳入标准的患者中，111 名（24.8%）接受了再次手术。患者初次斜视手术后平均随访 5.4 ± 3.0 年。初次手术仅涉及水平肌、仅涉及垂直肌、水平和垂直肌的患者的再次手术率分别为 120 例中的​​ 29 例（24.2%）、169 例中的 33 例（19.5%）和 159 例中的 49 例（30.8%）。P  = .05）。最初手术的肌肉数量是进行斜视手术再次手术的唯一独立预测因素（比值比，1.27；95% 置信区间，1.03–1.57；P  = .03）。最初手术的肌肉数量也与第一次再次手术的时间较短有关（风险比，1.22；95% 置信区间，1.02–1.46；P  = .03）。首次手术年龄、TED 诊断与首次斜视手术之间的时间、性别、种族和可调节缝线的使用与再次手术时间无关。

结论

大约四分之一的 TED 患者在斜视手术后需要再次手术。接受手术的肌肉数量是接受再手术和首次再手术时间的唯一独立预测因素。