Section of Ophthalmology, VA Medical Center, Providence, Rhode Island 02908, USA.
Ophthalmology. 2011 Mar;118(3):507-14. doi: 10.1016/j.ophtha.2010.07.023. Epub 2010 Oct 29.
To investigate the prevalence and predictors of intraoperative and 90-day postoperative ocular complications associated with cataract surgery performed in the United States Veterans Health Administration (VHA) system.
Retrospective cohort study.
Forty-five thousand eighty-two veterans who underwent cataract surgery in the VHA.
The National Patient Care Database was used to identify all VHA patients who underwent outpatient extracapsular cataract surgery and who underwent only 1 cataract surgery within 90 days of the index surgery between October 1, 2005, and September 30, 2007. Data collected include demographics, preoperative systemic and ocular comorbidities, intraoperative complications, and 90-day postoperative complications. Adjusted odds ratios (ORs) of factors predictive of complications were calculated using logistic regression modeling.
Intraoperative and postoperative ocular complications within 90 days of cataract surgery.
During the study period, 53786 veterans underwent cataract surgery; 45082 met inclusion criteria. Common preoperative systemic and ocular comorbidities included diabetes mellitus (40.6%), chronic pulmonary disease (21.2%), age-related macular degeneration (14.4%), and diabetes with ophthalmic manifestations (14.0%). The most common ocular complications were posterior capsular tear, anterior vitrectomy, or both during surgery (3.5%) and posterior capsular opacification after surgery (4.2%). Predictors of complications included: black race (OR, 1.38; 95% confidence interval [CI], 1.28-1.50), divorced status (OR, 1.10; 95% CI, 1.03-1.18), never married (OR, 1.26; 95% CI, 1.14-1.38), diabetes with ophthalmic manifestations (OR, 1.33; 95% CI, 1.23-1.43), traumatic cataract (OR, 1.80; 95% CI, 1.40-2.31), previous ocular surgery (OR, 1.29; 95% CI, 1.02-1.63), and older age.
In a cohort of United States veterans with a high preoperative disease burden, selected demographic factors and ocular comorbidities were associated with greater risks of cataract surgery complications. Further large-scale studies are warranted to investigate cataract surgery outcomes for non-VHA United States patient populations.
调查在美国退伍军人事务部（VHA）系统中进行白内障手术相关的术中及术后 90 天眼部并发症的发生率和预测因素。
回顾性队列研究。
在 VHA 接受白内障手术的 45082 名退伍军人。
利用国家患者护理数据库，确定了 2005 年 10 月 1 日至 2007 年 9 月 30 日期间，在门诊施行囊外白内障手术且术后 90 天内仅施行 1 次白内障手术的所有 VHA 患者。收集的数据包括人口统计学特征、术前全身和眼部合并症、术中并发症以及术后 90 天内的眼部并发症。使用逻辑回归模型计算预测并发症的因素的调整后比值比（OR）。
白内障手术后 90 天内的术中及术后眼部并发症。
在研究期间，53786 名退伍军人接受了白内障手术；45082 名符合纳入标准。常见的术前全身和眼部合并症包括糖尿病（40.6%）、慢性肺部疾病（21.2%）、年龄相关性黄斑变性（14.4%）和伴有眼部表现的糖尿病（14.0%）。最常见的眼部并发症是术中后囊膜撕裂、前玻璃体切割术或两者同时发生（3.5%）以及术后后囊膜混浊（4.2%）。并发症的预测因素包括：黑人种族（OR，1.38；95%置信区间[CI]，1.28-1.50）、离婚（OR，1.10；95% CI，1.03-1.18）、未婚（OR，1.26；95% CI，1.14-1.38）、伴有眼部表现的糖尿病（OR，1.33；95% CI，1.23-1.43）、外伤性白内障（OR，1.80；95% CI，1.40-2.31）、既往眼部手术（OR，1.29；95% CI，1.02-1.63）和年龄较大。
在一群术前疾病负担较高的美国退伍军人中，选择特定的人口统计学因素和眼部合并症与白内障手术并发症的风险增加相关。需要进一步开展大规模研究来调查非 VHA 美国患者人群的白内障手术结局。
