Rates and associated risk factors for cataract surgery complications in academic medical centers

To evaluate sociodemographic and clinical factors with postoperative complications after cataract surgery at academic medical centers in the United States.

16 U.S. academic medical centers contributing to the Sight Outcomes Research Collaborative (SOURCE) big data repository.

Retrospective, multicenter cohort study.

Adults undergoing cataract surgery between 2010 and 2023 were identified from the SOURCE database. Sociodemographic and clinical predictors including race, ethnicity, primary language, and prior intraocular surgery were assessed. Postoperative complications within 6 months were identified using Current Procedural Terminology/International Classification of Diseases codes. Multivariate cox regression estimated hazard ratios with 95% confidence intervals.

78 565 eyes were analyzed (mean age 70.8 ± 8.9 years, 59% female, 12.6% Black). At 6 months, 1.49% of eyes developed a complication and 0.10 developed a severe adverse complication. Independent predictors of any complication included male sex (hazard ratio [HR] 1.14; P < .01), Black race (HR 1.66; P < .01), complex surgery (HR 1.23; P < .01), combined intraocular procedures (HR 1.33; P < .01), prior intraocular surgery (HR 1.18; P < .01), and poorer preoperative vision (HR 1.10; P < .01). Severe adverse complications were more likely among men (HR 1.54; P = .02) and those with poorer vision (HR 1.62; P < .01), but less likely with increasing age (HR 0.95; P < .01), urban residence (HR 0.33; P < .01), and having 1 or more children in the household (HR 0.32; P = .03).

Sociodemographic and clinical factors that increased risk of postoperative outcomes after cataract surgery included Black race, male sex, and poor preoperative vision. Older age, urban residence, and children in the household were protective. Incorporating social determinants of health into perioperative risk stratification may improve surgical equity and outcomes.