Strabismus surgery charges at ambulatory facilities across the United States

To identify factors associated with variation in strabismus surgery charges at hospital-owned facilities across the United States.

This cross-sectional study included all strabismus-related patient encounters in the National Ambulatory Surgery Sample over a 5-year period (January 2016 to December 2020). The primary outcome was total charge per encounter. Multivariable linear regression was used to estimate the association of charge per encounter with patient, hospital, and regional characteristics, adjusting for procedure complexity and inflation. Sampling weights were used to generate nationally representative estimates and appropriate standard errors.

We included 154,005 patient encounters. Most surgeries were performed on pediatric patients (70%) and at teaching facilities (92%). The median charge per encounter was $12,889 (IQR, $8,840 to $17,573). Compared with the Midwest, charges were higher in the Northeast by 20.0% (95% CI, 8.4%, 32.9%; P = 0.0004) and South by 15.9% (95% CI, 4.8%-28.1%; P = 0.004). Nonteaching hospitals had 35.0% (95% CI, 17.6%-55.0%; P < 0.0001) higher charges compared with teaching hospitals. Rural hospitals had 26.6% (95% CI, 19.4%-33.1%; P < 0.0001) lower charges compared to urban hospitals. Patients residing in ZIP codes within the lowest income quartile had on average 6.8% (95% CI, 1.8%-12.2%; P = 0.0079) higher charges than those in the highest income quartile.

Our findings highlight substantial variation nationwide in charges for strabismus surgeries, raising important questions about how these differences may influence subspecialty geographic distribution of care and affect treatment access for patients with strabismus.