KATARAKT CERRAHİSİ SONUÇLARININ DEĞERLENDİRİLMESİ: YAŞAM KALİTESİ, MALİYET VE KLİNİK ÖZELLİKLER ARASINDAKİ İLİŞKİ

Yıl 2024, Cilt: 27 Sayı: 1, 21 - 42, 27.03.2024

Demet Gökmen Kavak , Yasemin Akbulut

https://doi.org/10.61859/hacettepesid.1321282

Öz

Türkiye’de ve dünyada görme engelliliğine neden olan en yaygın göz hastalıklarından birisi katarakttır ve tedavi amacıyla yaygın olarak uygulanan katarakt cerrahisi sayılarında giderek belirgin bir artış yaşanmaktadır. Bu durum katarakt cerrahisine yönelik sunulan hizmetlerin kalitesi ve maliyetine olan ilgiyi artırmaktadır. Bu araştırmanın amacı, katarakt cerrahisi öncesi ve sonrası sağlıkla ilişkili yaşam kalitesini belirlemek, katarakt cerrahisinin maliyetini hesaplamak, sosyo-demografik, klinik, ameliyat, hizmet sunucu, tedavi görülen klinik türü özellikleri ve maliyet ile sağlıkla ilişkili yaşam kalitesi arasındaki ilişkiyi incelemektir. Çalışma, prospektif, kesitsel türde ve analitik bir klinik alan araştırmasıdır. Çalışmaya, katarakt cerrahisi uygulanan, katarakta eşlik eden göz hastalığı bulunmayan, 18 yaş ve üstü, araştırmaya katılmaya gönüllü 363 hasta dâhil edilmiştir. Hastaların yaşam kalitesi verileri “Amerikan Ulusal Göz Sağlığı Enstitüsü Görme İşlevleri Anketi” ile katarakt cerrahisi maliyetine ilişkin veriler hasta faturalarından; klinik, ameliyat, hizmet sunucu özellikleri ve tedavi görülen klinik türüne yönelik veriler hasta dosyalarından toplanmıştır. Hastaların ameliyat sonrası yaşam kalitesi bileşik puan ortalaması (96,02±5,56), ameliyat öncesi yaşam kalitesi puan ortalamasına göre (82,77±11,89) daha yüksek bulunmuştur. Ameliyat sonrası yaşam kalitesi değişimi, ortalama 13,24 (±12,84) puan değerinde istatistiksel olarak anlamlı bir artış göstermektedir. Katarakt cerrahisi toplam maliyeti ile hastaların tedavi gördükleri klinik türleri arasında istatistiksel olarak anlamlı bir ilişki bulunmuştur. Katarakt cerrahisi toplam maliyeti ile hastaların klinik, ameliyat ve hizmet sunucu özellikleri ile ameliyat sonrası yaşam kalitesi değişimi arasında istatistiksel olarak anlamlı bir ilişki bulunmamaktadır. Katarakt cerrahisi hastaların yaşam kalitesini artırmaktadır. Katarakt cerrahisi hastalarının ameliyat öncesi ve ameliyat sonrası yaşam kalitesinin ölçülmesi, ameliyata uygunluğun belirlenmesi ve ameliyatın etkinliğinin izlenmesi açısından yararlı bilgiler sağladığından rutin hasta izlem sürecine dâhil edilebilir. Katarakt cerrahisi toplam maliyeti SUT paket fiyatının üstündedir. Katarakt cerrahisine yönelik paket fiyat uygulaması gözden geçirilerek, maliyetlerin kanıta dayalı olarak belirlenmesi değerlendirilebilir.

Anahtar Kelimeler

Katarakt Cerrahisi, Yaşam Kalitesi, Maliyet, Sağlık Sonuçları

Destekleyen Kurum

-

Proje Numarası

-

Teşekkür

Yazarlar çalışmaya gönüllü olarak katılan hastalara, hastanedeki sağlık çalışanlarına ve çalışmayı destekleyen hastane yönetim ekibine teşekkür eder.

EVALUATION OF CATARACT SURGERY RESULTS: THE RELATIONSHIP BETWEEN QUALITY OF LIFE, COST AND CLINICAL FEATURES

Öz

Cataract is one of the most common eye diseases that lead to visual impairment, not only in Turkey but also worldwide. There has been a significant increase in the number of cataract surgeries performed for treatment purposes. This increase has sparked interest in the quality and cost of services provided for cataract surgery. The aim of this study is to assess the health-related quality of life before and after cataract surgery, calculate the cost of cataract surgery, examine socio-demographic and characteristics, surgery details, service providers, and types of clinic involved, and explore the relationship between cost and health-related quality of life. The study is a prospective, cross-sectional and analytical clinical field study. It includes a total of 363 patients aged 18 years and older who underwent cataract surgery, did not have eye any accompanying eye diseases with their cataracts, and who volunteered to participate. Patient quality of life data of were collected using “American National Eye Health Institute Visual Functions Questionnaire”, while data on the cost of cataract surgery were derived from patient invoices. Information regarding clinic, surgery, service provider characteristics, and the type of clinic involved was obtained from patient records. The mean postoperative quality of life composite score of the patients (96.02±5.56) was found to be higher than the mean score of preoperative quality of life (82.77±11.89). The change in quality of life after surgery showed a statistically significant increase with a mean score of 13.24 (±12.84). A statistically significant correlation was observed between the total cost of cataract surgery and the types of clinics where patients were treated. However, there was no statistically significant relationship between the total cost of cataract surgery and the clinical, surgical and service provider characteristics of the patients and the change in the postoperative quality of life. Cataract surgery significantly improves the quality of life of patients. It can be integrated into routine patient follow-up processes as it provides valuable insights for measuring the preoperative and postoperative quality of life of cataract surgery patients, assessing their suitability for surgery, and monitoring the effectiveness of the procedure. Notably, the total cost of cataract surgery exceeds the SUT package price. An evidence-based approach to determining costs can be considered by reviewing the package pricing for cataract surgery.

Anahtar Kelimeler

Cataract Surgery, Quality of Life, Cost, Health Outcomes

Proje Numarası

-

Kaynakça

• Alim, S. (2013). Fakoemülsifikasyon yöntemi ile komplikasyonsuz katarakt cerrahisi sonrası erken dönem klinik sonuçlar. Journal of Contemporary Medicine, 3(2), 95-100.
• Alpar, R. (2010). Spor, Sağlık ve Eğitim Bilimlerinden Örneklerle Uygulamalı İstatistik ve Geçerlik-Güvenirlik. Detay Yayıncılık.
• Amedo, A. O., Koomson, N. Y., Pascal, T. M., & Kumah, D. B. (2016). Quality of life of cataract patients before and after surgery-evidence from four rural communities in Ghana. Mathews Journal of Ophthalmology, 1(1), 1-7.
• American Ophthalmology Academy. (2013). Science News. https://www.sciencedaily.com/releases/2013/11/131115104553.htm
• Balley, R. S. (2015). Katarakt, 5 Dakikada Göz Hastalıklarının Teşhisi. (Çeviri: Torun Acar B.) Ayrıntı Basım ve Yayıncılık, Ankara.
• Baltussen, R., Sylla, M., & Mariotti, S. P. (2004). Cost effectiveness anaysis of cataract surgery: a global and regional analysis. Bull World Health Organ, 82(5), 338-345.
• Barnsley, J., Williams, A. P., & Cockerill, R. (1999). Physician characteristics and the physician-patient relationship. Impact of sex, year o f graduation, and specialty. Canadian Family Physician,45, 935-42.
• Bayraktar, Ş., Cebeci, Z., Gözüm, N., & Gücükoğlu, A. (2016). Senil kataraktı olan hastalarda operasyon öncesi ve sonrası görmeye bağlı yaşam kalitesi değerlendirilmesi. İstanbul Tıp Fakültesi Dergisi, 79(2), 54-60.
• Bourne, R. R, Stevens, G. A, & White, R. A. (2013). Causes of vision loss worldwide, 1990-2010:a systematic analysis. Lancet Glob Health, 1(6), 339-349.
• Braithwaite, T., Melanie, Calvert M., Gray, A., Pesudovs, K., & Denniston, A.K. (2019). The use of patient reported outcome research in modern ophthalmology: impact on clinical trials and routine clinical practice. Patient Related Outcome Measures, 10, 9-24.
• Büyüköztürk, Ş. (2018). Sosyal bilimler için veri analizi el kitabı. Pegem Atıf İndeksi
• Chew, M., Chiang, P. P., Zheng, Y., Lavanya, R., Wu, R., Saw, S. M., Wong, T. Y., & Lamoureux, E. L. (2012) The impact of cataract, cataract types, and cataract grades on vision-specific functioning using rasch analysis. Am J Ophthalmol, 154, 29–38.
• Congdon, N., Yan, X., Lansingh, V., Sisay, A., Muller, A., Chan, V., Jin, L., Meltzer, M. E., Karumanchi S. M., Guan, C., Vuong, Q., Rivera, N., Omawal, J. M., & He, M. (2013) Assessment of cataract surgical outcomes in settings where follow-up is poor: PRECOG, a multicentre observational study. Lancet Glob Health; 1, e37–45
• Cron, B. C. (2019). How to Use SPSS®: A Step-By-Step Guide to Analysis and Interpretation. Routledge.
• Danquah, L., Kuper, H., Eusebio, C., Rashid, M. A., Bowen, L., Foster, A., & Polack, S. (2014). The long term ımpact of cataract surgery on quality of life, activities and poverty: results from a six year longitudinal study in Bangladesh and the Philippines. PLOS ONE, 9(4), e94140.
• Denis, D.J. (2018). SPSS Data Analysis For Univariate, Bivariate, and Multivariate Statistics. John Wiley & Sons.
• Desai, P. (1996). The Outcomes of Cataract-Surgery The Relationships Between Visual Acuity, Visual Function and Quality in Life. PhD Thesis, London School of Hygiene&Tropical Medicine.
• Dünya Sağlık Örgütü, DSÖ (2010). Action plan for the prevention of avoidable blindness and visual impairment, 2009-2013. http://www.who.int/blindness/actıon_plan_ wha62-1-english.pdf
• Eisenberg, J.M. (1986). Doctors Decisions and The Cost of Medical Care: The Reasons for Doctors' Practice Patterns and the Way to Change Them. Ann Arbor, MI: Health Administration Press.
• Essue, B. M., Li, Q., Biostat, M,. Stat, A., Hackett ,M. L., Keay, L., Lezzi, B., Tran, K. D., Phuc, H. T., & Jan, S. (2014). Multicenter prospective cohort study of quality of life and economic outcomes after cataract surgery in Vietnam. American Academy of Ophthalmology, 121, 2138-2146.
• Field, A. (2009). Discopering Statistics Using SPSS, 3th. Ed.Sage Publications.
• Gollogly, H. E., Hodge, D. O., St. Sauver, J. L., & Erie, J. C. (2013). Increasing incidence of cataract surgery: Population-based study. J Cataract Refract Surg, 39(9), 1383-1389.
• Gothwal, V.K., & Wright T.A., Lamoureux, E.L., Pesudovs, K. (2010). Measuring outcomes of cataract surgery using the Visual Function Index-14 Cataract Refract Surg, 36, 1181-1188.
• Gök, F. (2018). Katarakt Cerrahisi Uygulanan Hastaların Ameliyat Öncesi ve Sonrası Yaşam Kalitesinin Değerlendirilmesi. İstanbul Üniversitesi Sağlık Bilimleri Enstitüsü Cerrahi Hastalıkları Hemşireliği Anabilim Dalı. Yayımlanmamış Yüksek Lisans Tezi.
• Gözüm, N. (2012). Katarakt ve tedavisi. Klinik Gelişim Dergisi, 25, 12-15.
• Güler, C. (2001). Gözün Refraktif Durumu ve Muayene Yöntemleri. Bölüm 4, Temel Göz Hastalıkları. Aydın, P., Akova, Y.A. (Editörler) 1. Baskı, Ankara, Güneş Kitabevi s.:93-102.
• Gündoğan, F. C., Kocak, N., Akyıldız, R., Yolcu, U., İlhan, A., &Aydın, I. (2015). The prevalence and causes of visual impairment in young Turkish men. Pak J Med Sci, 31(4), 837-842.
• Hussey, P.S., Wertheimer, S., & Mehrotra, A. (2013) The association between health care quality and cost a systematic review. Ann Intern Med, 158(1), 27-34.
• Ibrahim, N., Pozo-Martin, F., & Gilbert, C. (2015). Direct non-medical costs double the total directcosts to patients undergoing cataract surgery in Zamfara state, Northern Nigeria: a case series. BMC Health Services Research, 15(163), 2-7.
• International Consortıum For Health Outcomes Measurement, ICHOM (2017). Cataracts Data Collection Reference Guide. Version 2.01. https://ichom.org/files/medical-conditions/cataracts/cataracts-reference-guide.pdf.
• İsmi, T. (2011). Glokomlu ve Glokomu Olmayan Hastalarda Katarakt Cerrahisinin Sonuçlarının Karşılaştırılması. Mersin Üniversitesi Tıp Fakültesi Göz Hastalıkları Anabilim Dalı Yayımlanmamış Uzmanlık Tezi.
• Kamış, Ü., Zengin, N., Turgut Öztürk, B., Özkağnıcı, A., & Kılınç, A.C. (2006). Katarakt cerrahisinin görme fonksiyonu ve yaşam kalitesine etkisi. Glokom-Katarakt Dergisi, 1(2), 127-132.
• Karagöz, Y. (2019). SPSS 23 ve AMOS 23 Uygulamalı İstatistiksel Analizler. Nobel Akademik Yayıncılık.
• Khan, N. M., Lin, S., Guan, L., & Guo, B. (2014). A visual evaluation framework for in-home physical rehabilitation. IEEE International Symposium, 237-240.
• Lau, J., Michon, J. J., Chan, W. S, & Ellwein, K. B. (2002). Visual acuity and quality of life outcomes in cataract surgery patients in Hong Kong. Br J Ophthalmol, 86, 12-17.
• Laureano, A., Rementería-Capelo, Jorge, L., García-Pérez, Juan Gros-Otero, Aida Morán, José M Sánchez-Pina, Inés Contreras. (2020). Visual and Refractive Outcomes of Cataract Surgeries Performed in One Year in a Private Practice Setting: Review of 2714 Procedures. J Ophthalmol. 4, 2020. doi: 10.1155/2020/2421816.
• Leech, N. L., Barrett, K. C., & Morgan, G. A. (2005). SPSS for Intermediate Statistics: Use and Interpretation. Psychology Press.
• Lindfield, R., Vishwanath, K., Ngounou, F., & Khanna, R.C. (2012). The challenges in improving outcome of cataract surgery in low and middle income countries. Indian Journal of Ophthalmology, 60(5), 464-469.
• Lubahn, J. G., Donaldson, K. E., Culbertson, W. W., & Yoo, S. H. (2014). Operating times of experienced cataract surgeons beginning femtosecond laser–assisted cataract surgery. J Cataract Refract Sur, 40, 1773-1776.
• Lundström, M., Barry, P., Henry, Y., Rosen, P., & Stenevi, U. D (2012). Evidence-based guidelines for cataract surgery: Guidelines based on data in the European Registry of Quality Outcomes for Cataract and Refractive Surgery database. J Cataract Refract Surg, 38, 1086-1093.
• Lundström, M., Stenevi U., & Thorburn, W. (1999). Gender and cataract surgery in Sweden 1992–1997 A retrospective observational study based on the Swedish National Cataract Register. Acta Ophthalmol. Scand, 77, 204-208.
• Lurie, N., Margolis K. L., & Macgovem, P. G. (1997). Why do patients of female physicians have higher rates of breast and cervical cancer screening? J Gen Intern Med, 12(1), 34-43.
• Mangione, C.M, Lee, P.P, Pitts, J., Gutierrez, P., Berry, S., Hays ,R.D. (1998) Psychometric properties of the National Eye Institute visual function questionnarie (NEI VFQ). Arch of Ophthalmol, 116:1496-1504.
• Mangione, C. (2000). NEI VFQ-25 Scoring algorithm. version 2000: The National Eye Institute 25-item visual function questionnaire (VFQ-25). Los Angeles, CA, UCLA.
• Mangione, C. M., Lee P. P., Gutierrez, P. R, Spritzer, K., Berry, S., & Hays, R. D. (2001). Development of the 25-item National Eye Institute visual function questionnaire. Arch Ophthalmol, 119(7), 1050-1058.
• Manning, S., Barry P, Henry Y, Rosen P, Stenevi U., & Lundström, M. (2015). Cataract surgery outcomes in corneal refractive surgery eyes: Study from the European Registry of Quality Outcomes for Cataract and Refractive Surgery. J Cataract Refract Surg, 41(11), 2358-2365.
• OECD Stat (2020). https://stats.oecd.org/Index.aspx?ThemeTreeId=9.
• Öztürk, A. (2017). Türkiye Sağlıkta Kalite Sistemi. Sağlıkta Kalite ve Verimlilik. Önal B. (Editör) T.C. Bilim, Sanayi ve Teknoloji Bakanlığı Yayın No:736.
• Panteleon, L. (2019). Why measuring outcomes is important in health care. Journal of Veterinary Internal Medicine, 33:356-362.
• Pin G. P., Salowi, M. A., Adnan, T. H., & Sa'at, N. (2016). The 8th Report of the National Eye Database 2014. The Ministry of Health Malaysian Society of Ophthalmology. National Eye Database (NED) Registry Coordinating Centre c/o Clinical Research Centre Level 4, Specialist Office Hospital Selayang Lebuhraya Selayang -Kepong 68100 Batu Caves Selangor, Malaysia.
• Polack, S., Eusebio, C., Mathenge, W., Wadud, Z., Mamunur, A. K. M., Fletcher, A., Foster, A., & Kuper, H. (2010). The Impact of Cataract Surgery on Health Related Quality of Life in Kenya, the Philippines, and Bangladesh. Ophthalmic Epidemiology, 17(6), 387-399.
• Porter, M.E., Lee, T.H. (2013). Strategy that Will Fix Health Care. Harvard Business Review 19. https://hbr.org/2013/10/the-strategy-that-will-fix-health-care
• Räsänen, P., Krootila, K., Sintonen, H., Leivo, T., Koivisto, A. M., Ryynänen, O. P., Blom, M., & Roine, R. P. (2006). Cost-utility of routine cataract. Health and Quality of Life Outcomes, 4(74), 1-11.
• Rosenblatt, R. A., & Moscovice, I. S. (1984). The physician as gatekeeper: Determinants of physicians’ hospitalization rates. Medical Care. 22(2), 150-59.
• Roter, D. L., & Hall, J. A. (1998) Why physician gender matters in shaping the physician-patient relationship. Journal of Women’s Health, 7(9), 1093-1097.
• Sağlık Hizmetleri Genel Müdürlüğü, SHGM (2017). Katarakt Cerrahisi Klinik Protokolü. Erişim Adresi: [https://dosyamerkez.saglik.gov.tr/Eklenti/11070, kataraktcerrahisiklinikpro2605pdf.pdf?0]. Erişim Tarihi: 06/07/2020.
• Sağlık Hizmetleri Genel Müdürlüğü, SHGM (2018). Klinik Kalite Gösterge Kartları-Katarakt Cerrahisi. https://dosyamerkez.saglik.gov.tr/Eklenti/28381,katarakt-gosterge-kartlari-pdf.pdf?0.
• Sağlık Hizmetleri Genel Müdürlüğü, SHGM (2021). Klinik Kalite Ölçme ve Değerlendirme Rehberi-Sürüm 1.1. Erişim Adresi: [https://shgmklinikkalite.saglik.gov.tr/Eklenti/40776/0/klinik-klate-rehber--basim-formatipdf.pdf]. Erişim Tarihi:01/06/2021.
• Schippert, A. C., Jelin, E., Moe, M. C., Heiberg, T., & Grov, E. K. (2018). The impact of age-related macular degeneration on quality of life and its association with demographic data: results from the NEI VFQ-25 questionnaire in a Norwegian population. Gerontology & Geriatric Medicine, 4, 1-9.
• Seid, M., Yu, H., Lotstein, D., & Varni, J. W. (2005). Using health-related quality of life to predict and manage pediatric healthcare. Expert Rev Pharmacoecon Outcomes Res, 5, 489-498.
• STATISTA (2020). Erişim Adresi: [https://www.statista.com/statistics/312244/hospital-and-physician-costs-of-a-cataract-surgery-by-country/] Erişim Tarihi: 12.10.2020.
• Tabin, G., Chen, M., & Espandar, L. (2008) Cataract surgery for the developing world. Current Opinion in Ophthalmology, 19, 55-59.
• Toprak, A. B., Eser, E., Guler, C., Baser, F. E., & Mayalı, H. (2005). Cross validation of Turkish version 25 item national eye institute visual functioning questionnarie (NEI VFQ-25). Ophthalmic Epidemiol, 12(4), 259-269.
• Tsugawa, Y., Newhouse, J. P., Zaslavsky, A. M., Blumenthal, D. M., & Jena, A. B. (2017). Physician age and outcomes in elderly patients in hospital in the US: observational study. BMJ, 357, j1797.
• Wade, T. J., & Guo, J. J. (2010). Linking improvements in health-related quality of life to reductions in medicaid costs among students who use schoolbased health centers. Am J Public Health, 100(9), 1611-1616.
• Wang, W., Yan, W., Fotis, K., Prasad, N. M., Lansingh, V. C., Taylor, H. R., Finger, R. P., Facciolo, D., & He, M. (2016). Cataract surgical rate and socioeconomics: a global study. Investigative Ophthalmology and Visual Sciences, 57(14), 5872-5881.
• Willke, R. J., Burke, L. B., & Erickson, P. (2004). Measuring treatment impact: a review of patient-reported outcomes and other efficacy endpoints in approved product labels Control. Clin. Trials, 25, 535-552.
• Zhu, M., Yu, J., Zhang, J., Yan, Q., & Liu, Y. (2015). Evaluating vision-related quality of life in preoperative age-related cataract patients and analyzing its influencing factors in China: a cross-sectional study. BMC Ophthalmology, 15(160), 1-7.