Abstract：
OBJECTIVE: To utilize data mining for analysis of corneal transplantations (CT) in Florida from 2005-2014, segmented by demographics, geography, and transplantation technique.
METHODS: A retrospective, database study was performed utilizing data queried from the Healthcare and Cost Utilization Project using Current Procedural Terminology codes for lamellar keratoplasty (ALK), endothelial keratoplasty (EK), and penetrating keratoplasty (PKP). Payer status, ethnic group, age, gender, and geography (urban versus rural) was extracted from each surgical encounter and reconfigured to provide a \"clean\", congruous dataset for statistical analysis. This Institutional Review Board-approved study did not utilize identifiable patient information; thus, individual informed consent was not required.
RESULTS: From 2005-2014, CT (n=28,607) represented less than 1% of the total ambulatory surgeries (n=12,695,932) performed in Florida. EK volume increased while PKP and ALK volume decreased, year-over-year. Statistical significance was found between transplantation technique by sex (P<0.001) and ethnic group (P<0.001). The largest sex discrepancy was EK (59% female, 41% male). White patients underwent relatively fewer PKP than EK (71% vs. 83% of totals), while Black patients underwent relatively more PKP than EK (14% vs 6% of totals). Statistical significance was found between techniques by payer (P<0.001). Medicare was the most common payer for all techniques, but ALK and PKP had higher percentages of private insurance and self-pay. No statistical significance was found between techniques by geographic location. Corneal edema (22.4%), endothelial dystrophy (17.5%), and bullous keratopathy (10.9%) were erroneously coded as indications for ALK. Corneal scars (2.5%) and corneal opacity (1.7%) were erroneously coded as indications for EK.
CONCLUSIONS: CT rates in Florida appear to overrepresent the female sex and underrepresent ethnic minorities, with propensities between PKP and African Americans, EK and female patients, and EK and Medicare reimbursement. Our study further confirms the utility of data mining for providing efficient, detailed, and practical insights into ophthalmology procedures, while highlighting the intrinsic challenges of large datasets.
METHODS: A retrospective, database study was performed utilizing data queried from the Healthcare and Cost Utilization Project using Current Procedural Terminology codes for lamellar keratoplasty (ALK), endothelial keratoplasty (EK), and penetrating keratoplasty (PKP). Payer status, ethnic group, age, gender, and geography (urban versus rural) was extracted from each surgical encounter and reconfigured to provide a \"clean\", congruous dataset for statistical analysis. This Institutional Review Board-approved study did not utilize identifiable patient information; thus, individual informed consent was not required.
RESULTS: From 2005-2014, CT (n=28,607) represented less than 1% of the total ambulatory surgeries (n=12,695,932) performed in Florida. EK volume increased while PKP and ALK volume decreased, year-over-year. Statistical significance was found between transplantation technique by sex (P<0.001) and ethnic group (P<0.001). The largest sex discrepancy was EK (59% female, 41% male). White patients underwent relatively fewer PKP than EK (71% vs. 83% of totals), while Black patients underwent relatively more PKP than EK (14% vs 6% of totals). Statistical significance was found between techniques by payer (P<0.001). Medicare was the most common payer for all techniques, but ALK and PKP had higher percentages of private insurance and self-pay. No statistical significance was found between techniques by geographic location. Corneal edema (22.4%), endothelial dystrophy (17.5%), and bullous keratopathy (10.9%) were erroneously coded as indications for ALK. Corneal scars (2.5%) and corneal opacity (1.7%) were erroneously coded as indications for EK.
CONCLUSIONS: CT rates in Florida appear to overrepresent the female sex and underrepresent ethnic minorities, with propensities between PKP and African Americans, EK and female patients, and EK and Medicare reimbursement. Our study further confirms the utility of data mining for providing efficient, detailed, and practical insights into ophthalmology procedures, while highlighting the intrinsic challenges of large datasets.
摘要：
目的：利用数据挖掘分析2005-2014年佛罗里达州的角膜移植（CT），按人口统计学划分，地理,和移植技术。
方法：回顾性研究，数据库研究是利用从医疗保健和成本利用项目查询的数据进行的，使用板层角膜移植术（ALK）的当前程序术语代码，角膜内皮移植术(EK),穿透性角膜移植术（PKP）。付款人状态，民族,年龄,性别,从每次手术中提取地理(城市与农村)，并重新配置以提供“干净”，用于统计分析的数据集。这项机构审查委员会批准的研究没有利用可识别的患者信息；因此，不需要个人知情同意.
结果：从2005年至2014年，CT（n=28,607）在佛罗里达州进行的总门诊手术（n=12,695,932）中占不到1％。EK体积增加，而PKP和ALK体积减少，年复一年。性别（P<0.001）和种族（P<0.001）之间的移植技术差异有统计学意义。最大的性别差异是EK(59%是女性，41%男性）。与EK相比，白人患者接受的PKP相对较少（71％vs.总数的83%)，而Black患者的PKP相对高于EK（占总数的14％vs6％）。各技术之间的差异有统计学意义(P<0.001)。医疗保险是所有技术最常见的付款人，但ALK和PKP的私人保险和自费比例较高。按地理位置划分的技术之间没有发现统计学意义。角膜水肿（22.4%），内皮营养不良（17.5%），和大疱性角膜病变（10.9％）被错误地编码为ALK的适应症。角膜疤痕（2.5％）和角膜混浊（1.7％）被错误地编码为EK的适应症。
结论：佛罗里达州的CT率似乎过分代表了女性，而少数民族则不足。PKP和非裔美国人之间的倾向，EK和女性患者，以及EK和医疗保险报销。我们的研究进一步证实了数据挖掘的实用性，detailed,以及对眼科程序的实际见解，同时强调了大型数据集的内在挑战。
方法：回顾性研究，数据库研究是利用从医疗保健和成本利用项目查询的数据进行的，使用板层角膜移植术（ALK）的当前程序术语代码，角膜内皮移植术(EK),穿透性角膜移植术（PKP）。付款人状态，民族,年龄,性别,从每次手术中提取地理(城市与农村)，并重新配置以提供“干净”，用于统计分析的数据集。这项机构审查委员会批准的研究没有利用可识别的患者信息；因此，不需要个人知情同意.
结果：从2005年至2014年，CT（n=28,607）在佛罗里达州进行的总门诊手术（n=12,695,932）中占不到1％。EK体积增加，而PKP和ALK体积减少，年复一年。性别（P<0.001）和种族（P<0.001）之间的移植技术差异有统计学意义。最大的性别差异是EK(59%是女性，41%男性）。与EK相比，白人患者接受的PKP相对较少（71％vs.总数的83%)，而Black患者的PKP相对高于EK（占总数的14％vs6％）。各技术之间的差异有统计学意义(P<0.001)。医疗保险是所有技术最常见的付款人，但ALK和PKP的私人保险和自费比例较高。按地理位置划分的技术之间没有发现统计学意义。角膜水肿（22.4%），内皮营养不良（17.5%），和大疱性角膜病变（10.9％）被错误地编码为ALK的适应症。角膜疤痕（2.5％）和角膜混浊（1.7％）被错误地编码为EK的适应症。
结论：佛罗里达州的CT率似乎过分代表了女性，而少数民族则不足。PKP和非裔美国人之间的倾向，EK和女性患者，以及EK和医疗保险报销。我们的研究进一步证实了数据挖掘的实用性，detailed,以及对眼科程序的实际见解，同时强调了大型数据集的内在挑战。
