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Cataract Surgery Complexity and Surgical Complication Rates Among Medicare Beneficiaries With and Without Dementia

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

DOI

  • Suzann Pershing, Stanford University
  • ,
  • Victor W. Henderson, Stanford University
  • ,
  • Mary K. Goldstein, Stanford University
  • ,
  • Ying Lu, Stanford University
  • ,
  • M. Kate Bundorf, Stanford University
  • ,
  • Moshiur Rahman, Stanford University, University of Michigan, Ann Arbor
  • ,
  • Joshua D. Stein, University of Michigan, Ann Arbor

Purpose: To evaluate cataract surgery complexity and complications among US Medicare beneficiaries with and without dementia. Design: Retrospective claims-based cohort study. Participants: A 20% representative sample of Medicare beneficiaries, 2006-2015. Methods: Dementia was identified from diagnosis codes on or prior to each beneficiary's first-eye cataract surgery. For each surgery, we identified setting, routine vs complex coding, anesthesia provider type, duration, and any postoperative hospitalization. We evaluated 30- and 90-day complication rates—return to operating room, endophthalmitis, suprachoroidal hemorrhage, retinal detachment, retinal tear, macular edema, glaucoma, or choroidal detachment—and used adjusted regression models to evaluate likelihood of surgical characteristics and complications. Complication analyses were stratified by second-eye cataract surgery within 90 days postoperatively. Results: We identified 457,128 beneficiaries undergoing first-eye cataract surgery, 23,332 (5.1%) with dementia. None of the evaluated surgical complications were more likely in dementia-diagnosed beneficiaries. There was also no difference in likelihood of nonambulatory surgery center setting, anesthesiologist provider, or postoperative hospitalization. Dementia-diagnosed beneficiaries were more likely to have surgeries coded as complex (15.6% of cases vs 8.8%, P <.0001), and surgeries exceeding 30 minutes (OR = 1.21, 95% CI = 1.17-1.25). Conclusions: Among US Medicare beneficiaries undergoing cataract surgery, those with dementia are more likely to have “complex” surgery” lasting more than 30 minutes. However, they do not have greater likelihood of surgical complications, higher-acuity setting, advanced anesthesia care, or postoperative hospitalization. This may be influenced by case selection and may suggest missed opportunities to improve vision. Future research is needed to identify dementia patients likely to benefit from cataract surgery.

OriginalsprogEngelsk
TidsskriftAmerican Journal of Ophthalmology
Vol/bind221
Sider (fra-til)27-38
Antal sider12
ISSN0002-9394
DOI
StatusUdgivet - jan. 2021

Bibliografisk note

Funding Information:
Funding/Support: This work was supported by the National Institute on Aging (R03-AG056453). SP also received departmental support from the National Eye Institute (P30-EY026877) and Research to Prevent Blindness. The sponsor had no role in the design, methods, subject recruitment, data collection, analysis, or preparation of the paper. Financial Disclosures: SP is a consultant for Acumen, LLC (Burlingame, CA) and Verana Health (San Francisco, CA). VWH also received support from P50-AG047366. JDS also received support from R01-EY026641. YL also received supported from 1UL1TR003142. All authors attest that they meet the current ICMJE criteria for authorship.

Funding Information:
Funding/Support: This work was supported by the National Institute on Aging ( R03-AG056453 ). SP also received departmental support from the National Eye Institute ( P30-EY026877 ) and Research to Prevent Blindness . The sponsor had no role in the design, methods, subject recruitment, data collection, analysis, or preparation of the paper. Financial Disclosures: SP is a consultant for Acumen, LLC (Burlingame, CA) and Verana Health (San Francisco, CA). VWH also received support from P50-AG047366. JDS also received support from R01-EY026641. YL also received supported from 1UL1TR003142. All authors attest that they meet the current ICMJE criteria for authorship.

Funding Information:
Financial Support: National Institute on Aging R03-AG056453 (SP); departmental support from National Eye Institute and Research to Prevent Blindness. The funding organizations had no role in the design or conduct of this research.

Publisher Copyright:
© 2020

Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.

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