Intensity and complexity index of disease for strabismus surgery

The value of health care must be calculated by weighing quality of care with cost of care, and quality of care must be measured not only by objective clinical outcomes but also by resulting health-related quality of life and patient satisfaction. To date, no validated method allows this determination. In this article, we present results of a survey to determine an intensity and complexity index (ICI) for strabismus surgery and discuss how this information can be used in a larger system of determining treatment outcomes and value.

We surveyed the membership of the American Association for Pediatric Ophthalmology and Strabismus to determine the ICI for 20 specific surgical procedures on the extraocular muscles and for 17 add-on factors that correct for circumstances altering the difficulty of the surgical procedure.

Of the 620 surveys that were sent, 222 (36%) were returned and analyzed. Median ICI ranged from 1.00 for lateral rectus recession and for medial rectus recession to 2.00 for Harada-Ito and for superior oblique lengthening with silicone expander. Median ICI for add-on factors ranged from 0.50 for lateral incomitance, concurrent neurological syndrome, age 70 years or older, and ASA rating III or higher to 2.00 for complicated strabismus operation, eg, lost muscle.

The ICI is a new method of risk-adjusting a patient population undergoing strabismus surgery, thus allowing further evaluation of the outcome and the value of treatment of disease in that patient population.