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• W4233919387 abstract "Reply: We would like to reiterate that this study used the national health insurance claims data that encompass 98% of the population.1 These data offer details on medical procedures, treatments, and sociodemographic characteristics of the beneficiaries. Therefore, information was extracted using diagnostic and procedural codes, and these data may not include all the information we can attain through the medical record review. Rey et al. suggested the possibility of confusion bias in our study. In response to some of the confounding factors they have mentioned, the clinics and hospitals in South Korea operate throughout the year, and we are unaware of any institutions that close during summer. The investigation of prophylaxis protocols each institution incorporates is not feasible because although the claims data include the prescribed pharmaceuticals, it does not have procedure codes on how it was used. For example, there is no procedure code for intracameral injection, and we do not have commercially available antibiotic for intracameral injection in South Korea. The experience of surgeons is also unknown because these data would only be available through a nationwide survey. However, trainees start their residency or fellowship training in March; therefore, there is a greater chance that novice surgeons start operating in spring rather than in summer. Although the rate of intraoperative complications would be impossible to exactly calculate using the claims data, we included only the cases that would be given surgical codes for a routine, uneventful cataract surgery and excluded cases with a history of intraocular foreign body, combined glaucoma surgery, and vitrectomy. Foreigners would not be included in the dataset because they are not covered by the national insurance. The conjunctival culture results cannot be investigated using claims data because although whether it was done preoperatively can be detected using the procedure code, the culture results can only be found by reviewing the medical record. Rey et al. also suggested the possibility of an ecological fallacy. That is why we used regional average climate data instead of the national values and matched with the endophthalmitis incidences in the specific region. South Korea consists of 9 provinces and 7 metropolitan cities, and the regional climate variables would more accurately portray the effect of weather patterns on the development of endophthalmitis cases in a relatively distinct geographic area. The large sample size in our study was possible because we used the national health insurance database that includes almost 50 million patients, covering 98% of the total population. Rey et al. pointed out it is easy to find statistically significant bivariate associations with a huge sample size. However, the advantage of a large scale of data is that it allows a more precise estimate while having narrower margins of error.2 Moreover, the multivariate analysis in our study was performed after adjusting for patients' age, sex, and risk factors for post–cataract surgery endophthalmitis, which was found to be statistically significant in our previously published study that was analyzed with the same dataset.3 Although the national insurance claims data have advantages in that it is representative and comprehensive for a large patient population, it lacks some information such as laboratory results, severity of conditions, and health behavior of beneficiaries. The diagnosis and surgery can only be presumed using diagnostic and procedure codes, and we cannot find out every confounding factor that may affect the analysis. These limitations arise from the inherent nature of the claims data, and future studies that could adjust for other confounding factors would be useful in validating our results." @default.
• W4233919387 created "2022-05-12" @default.
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• W4233919387 date "2020-03-01" @default.
• W4233919387 modified "2023-10-14" @default.
• W4233919387 title "Reply" @default.
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• W4233919387 doi "https://doi.org/10.1097/j.jcrs.0000000000000092" @default.
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