A Population-Based Analysis of Long-Term Costs and Adverse Events Following Pneumatic Retinopexy and Pars Plana Vitrectomy.

PURPOSE: To comprehensively examine the cost effectiveness, re-attachment rate, and complications of pneumatic retinopexy (PnR) compared to pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) within a universal healthcare system.

DESIGN: Population-based, multi-center, consecutive, retrospective longitudinal cohort analysis.

STUDY POPULATION: We identified consecutive adults aged 50 and older requiring surgery for primary RRD over a 20-year interval between April 1, 2002 and March 31, 2022. Initial surgery was considered the index date for analyses.

INTERVENTION: PnR was compared to PPV in all analyses.

MAIN OUTCOME MEASURES: The primary analysis investigated the mean annualized healthcare costs comparing PnR to PPV over the two years following initial surgery. Secondary analyses examined the primary reattachment rate and complications.

RESULTS: In total, 28,162 eligible patients were identified, with 8,794 undergoing PnR and 16,871 undergoing PPV. The mean patient age was 65 years and 39% were women. The mean annualized cost after PnR was $8,924 and $11,937 after PPV (mean difference=$3,013, 95% confidence interval [CI]=$2,533-$3,493, p<0.001). The primary reattachment rate at 90 days after PnR was 83% and after PPV was 93% (p<0.001). The risk of cataract or glaucoma surgery was lower after PnR, and the frequency of ophthalmology clinic visits, intravitreal injections and anxiety was higher after PnR. Hospitalizations and long-term disability were less frequent after PnR.

CONCLUSIONS: PnR compared to PPV was associated with lower long-term healthcare costs. PnR appeared to be effective, safe and inexpensive, thus offering a viable option for improving access to RRD repair in appropriately selected cases.