Operative Costs and Anesthesia Exposure Time for Pediatric Glaucoma Surgeries

Background: Pediatric glaucomas are sight-threatening conditions that frequently require surgical intervention and may expose vulnerable young patients to repeated episodes of general anesthesia. While the clinical efficacy of pediatric glaucoma surgeries has been described, comparative data on operative cost and anesthesia exposure time are scarce, limiting evidence-based decision-making for surgeons, caregivers, and health systems. Objective: To quantify and compare the operative costs and total operating room (OR) time of common pediatric glaucoma surgeries, with particular attention to unilateral angle surgery versus immediately sequential bilateral angle surgery (ISBAS), and to single-incision ab interno trabeculotomy (SIT) versus other angle techniques. Methods: A retrospective review of patients who received glaucoma surgery by one of three experienced glaucoma surgeons between January 2012 and August 2019 at the University of Minnesota Medical Center. Each surgery was classified by type, cost, and operative time. Results: A total of 160 surgical encounters were analyzed. Average total cost was $6564 for all unilateral procedures, $6782 (±1952.03) for unilateral angle surgeries, and $11,391 (±2396) for ISBAS. Mean OR time was 121 min for all unilateral procedures, 120 min (±46.3) for unilateral angle surgeries, and 208 min (±53.8) for ISBAS-approximately the cost and time of two unilateral angle surgeries combined into a single anesthetic encounter. Compared to separate encounters for bilateral angle surgeries, ISBAS saved $2174 (p = 0.008) and trended toward saving 33 min of OR time (p = 0.068). Single-incision ab interno trabeculotomy (SIT) was $1647 more expensive than conventional incisional goniotomy or trabeculotome trabeculotomy (p < 0.0001) and reduced OR time by 23.5 min (p = 0.011). SIT was as expensive as 360-degree trabeculotomy ab externo with the iScience^TM catheter (p = 0.098) and reduced OR time by 74.4 min (p = 0.0004). There was no difference in complications between unilateral surgery and ISBAS. Conclusions: Reduced cost and a trend toward reduced anesthesia time support the use of ISBAS. SIT substantially reduced general anesthesia exposure for a neutral or slightly increased cost.