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Cataract Surgery Complexity and Surgical Complication Rates Among Medicare Beneficiaries With and Without Dementia
Suzann Pershing1, Victor W Henderson2, Mary K Goldstein3
1Byers Eye Institute at Stanford, Palo Alto, California, USA; VA Palo Alto Health Care System, Palo Alto, California, USA; Department of Health Research and Policy (Health Services Research), Stanford University, Palo Alto, California, USA.
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.