Endoscopic versus external dacryocystorhinostomy: temporal and regional trends in the United States Medicare population

Kshirsagar, Rijul S.; Vu, Priscilla; Liang, Jonathan

doi:10.1080/01676830.2019.1572767

Cited by 12 publications

(6 citation statements)

References 29 publications

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“…5 DCR is also a common ophthalmologic procedure with 8889 to 9760 surgical cases (or approximately 3 per 100 000) performed annually from 2000 to 2015 in the United States. 6 However, while exciting, new surgical fields also may hold potential pitfalls including complications and possibly perilous medicolegal climate. The stress of potential medicolegal litigation looms heavily on surgeons, with an estimated 99% of physicians in high-risk fields reporting malpractice suits over their lifetime.…”

Section: Introductionmentioning

confidence: 99%

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Medical Malpractice Trends in Dacryocystorhinostomy and Orbital Decompression

Tang

Goli

Higgins

et al. 2022

Am J Rhinol�Allergy

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Background and Objective This study aims to evaluate the medicolegal trends related to 2 common orbital surgeries: orbital decompression and dacryocystorhinostomy (DCR). These procedures are performed by ophthalmologists, otolaryngologists, and multidisciplinary teams of both specialists. Methods The Westlaw database was reviewed from 1980 to 2020 for medical malpractice cases involving orbital decompression and DCR surgeries. Data were compiled on plaintiff and defendant demographics, procedure performed, legal allegation, nature of injury, and verdict or settlement awards. The Ophthalmic Mutual Insurance Company was also queried for all malpractice cases pertaining to orbital decompression and DCR from 1995 to 2021. Results The Westlaw database included 60 cases (34 orbital decompression, 26 DCR); of these, 8 orbital decompression and 6 DCR cases met inclusion criteria. Of the 7 orbital decompression cases that were tried, a verdict in favor of the plaintiff occurred in 4 cases (57%). Of the 5 DCR cases that were tried, a verdict in favor of the plaintiff occurred in 2 cases (40%). A search of all claims at OMIC yielded 31 cases (15 orbital decompression, 16 DCR). 22 of 31 cases were either dismissed or resulted in no payment. The remainder was settled out of court, with only one case being tried and the verdict supporting the defendant. Conclusion Despite several thousand orbital decompressions and DCR surgeries being performed annually in the US, very few lawsuits involving these complex surgeries have gone to trial. However, of the cases that did go to trial, a relatively high proportion of verdicts for plaintiffs was observed.

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Section: Introductionmentioning

confidence: 99%

“…5 DCR is also a common ophthalmologic procedure with 8889 to 9760 surgical cases (or approximately 3 per 100 000) performed annually from 2000 to 2015 in the United States. 6…”

Section: Introductionmentioning

confidence: 99%

Medical Malpractice Trends in Dacryocystorhinostomy and Orbital Decompression

Tang

Goli

Higgins

et al. 2022

Am J Rhinol�Allergy

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“…The existing surgical methods include lacrimal intubation, YAG laser , external dacryocystorhinostomy (Ex-DCR) and EE-DCR [3][4]. For more than 100 years, Ex-DCR has been regarded as the "gold standard" for the treatment of chronic dacryocystitis, but it can't meet people's growing medical needs due to the shortcomings of facial skin scar, large trauma, affecting the function of "tear pump" and unable to deal with nasal complications at the same time [5][6][7]. Over the past 10 years, with the continuous improvement of endoscopic imaging system, ENT micro power system and other medical equipment, EE-DCR is highly recommended in clinic because of its incomparable advantages of Ex-DCR, such as no facial skin incision, minimally invasive and does not affect the function of "tear pump", simultaneous treatment of nasal complications, et al However, so far, the e cacy of EE-DCR has been reported differently, and its losers are not rare [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Endoscopic Endonasal Common Canaliculorhinostomy for Chronic Dacryocystitis with Small Lacrimal Sac in the Treatment of Failed Patients After EE-DCR

Sha

Zhang

2022

Preprint

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Background: Over the past 10 years, endoscopic endonasal dacryocystorhinostomy (EE-DCR）has a trend to gradually become the mainstream method for the treatment of nasolacrimal duct obstructive diseases , but the failure of EE-DCR is not rare in clinical treatment. Therefore, the study will explore the efficacy of treating patients with EE-DCR failure by endoscopic endonasal common canaliculorhinostomy (EE-CAR), in order to improve the success rate of reoperation in patients with EE-DCR failure. Method: Prospective non-randomized controlled study. Patients with EE-DCR failure caused by lacrimal sac nasal mucosal ostium atresia from April 2018 to January 2021 in Hankou Aier Eye Hospital were enrolled. They were divided into two groups according to the principle of voluntariness before surgery. Group A: underwent EE-CAR. Group B: underwent Endoscopic Endonasal Ostial Openning (EE-OO). The postoperative efficacy and complications of the two groups was compared. Results: 44 patients (48 eyes) were included in the comparative analysis, including 26 eyes in group A and 22 eyes in group B. Followed up at 6 months postoperative, the ostium of 22 eyes in group A remained open and the symptoms of tear overflow disappeared. The success rate of surgery was 84.62% (22/26), and 54.55% (12/22) in group B. There was significant difference between the two groups (P＜0.05). Conclusions: EE-CAR is better than conventional ostium opening in the treatment of patients with small lacrimal sac remnant after EE-DCR due to ostium atresia.

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“…9,10 Moreover, several authors have described the advantages of END-DCR compared to EXT-DCR, such as the absence of an external scar, less surgical time, earlier recovery, and fewer post-operative complications, 11 so that in past decades the endoscopic approach has gained popularity even if EXT-DCR is still the most used and preferred approach. 12 In fact, on one hand the external approach has historically provided reliable outcomes, while on the other the cost of endoscopic instrumentation, preference of general anaesthesia, marked learning curve, necessity of two surgeons (one ophthalmologist and one otolaryngologist) or one highly trained, and the impossibility of concomitant treatment of proximal pathologies, have limited endoscopic approaches in past decades. 13 The aim of this paper is to report our clinical and surgical experience on 245 consecutive cases of EXT-DCR analyzing the role of clinical presentation on long-term success rates; additionally, the cosmetic significance of the surgical scar as reported by patients was assessed.…”

Section: Introductionmentioning

confidence: 99%

The importance of clinical presentation on long-term outcomes of external dacryocystorhinostomies: Our experience on 245 cases

Resti

Vinciguerra

Bordato

et al. 2021

European Journal of Ophthalmology

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Purpose External dacryocystorhinostomy (EXT-DCR) is a surgical approach commonly used to treat post-canalicular acquired lacrimal obstruction whose success rate has been described, equally with endoscopic DCR, to be superior to other available treatments. Methods At San Raffaele Hospital, Milan (Italy), from January 2008 to December 2020, 245 EXT-DCRs were performed. All patients underwent routine pre-operative work-up including Jones tests and probing and irrigation of the lacrimal pathway; when necessary, a multidisciplinary approach with nasal endoscopy was performed. The surgical approach was followed by positioning of a bicanalicular stent which was left in place for 6 months. Success was defined as resolution of clinical signs/symptoms and free lacrimal flow on functional test. Results Of the cases enrolled, 26.9% were treated for recurrent epiphora (group 1), and 73.1% for epiphora associated with chronic dacryocystitis (group 2). After a median follow-up of 71 months, group 1 had success at T0 (1 month) and T1 (long-term) of 81.8% and 60.6%, respectively, compared to 93.8% and 77.7% in group 2. Statistical analysis showed a significant association with surgery both at T0 ( p = 0.018) and T1 ( p = 0.012) with group 2 showing better outcomes. Additionally, the cosmetic outcome of the external scar was defined as invisible in 91.8% of cases and slightly visible in 8.2%. Conclusions External dacryocystorhinostomy provides long-term reliable results particularly in case of chronic dacryocystitis. Moreover, the optimal esthetic outcome of the external scar should be no longer considered the only guiding principle of treatment modality, particularly in the elderly.

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Endoscopic versus external dacryocystorhinostomy: temporal and regional trends in the United States Medicare population

Cited by 12 publications

References 29 publications

Medical Malpractice Trends in Dacryocystorhinostomy and Orbital Decompression

Medical Malpractice Trends in Dacryocystorhinostomy and Orbital Decompression

Efficacy of Endoscopic Endonasal Common Canaliculorhinostomy for Chronic Dacryocystitis with Small Lacrimal Sac in the Treatment of Failed Patients After EE-DCR

The importance of clinical presentation on long-term outcomes of external dacryocystorhinostomies: Our experience on 245 cases

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