Byers 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.
Department of Epidemiology and Population Health, Stanford University, Palo Alto, California, USA; Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, California, USA; Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark.
Am J Ophthalmol. 2021 Jan;221:27-38. doi: 10.1016/j.ajo.2020.08.025. Epub 2020 Aug 20.
To evaluate cataract surgery complexity and complications among US Medicare beneficiaries with and without dementia.
Retrospective claims-based cohort study.
A 20% representative sample of Medicare beneficiaries, 2006-2015.
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.
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).
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.
评估美国医疗保险受益人与痴呆症患者和非痴呆症患者的白内障手术的复杂性和并发症。
回顾性基于索赔的队列研究。
2006 年至 2015 年医疗保险受益人的 20%代表性样本。
从每位受益人的第一只眼白内障手术之前或当时的诊断代码中确定痴呆症。对于每例手术，我们确定了手术环境、常规手术与复杂手术编码、麻醉提供者类型、手术持续时间以及任何术后住院情况。我们评估了 30 天和 90 天的并发症发生率——重返手术室、眼内炎、脉络膜下出血、视网膜脱离、视网膜裂孔、黄斑水肿、青光眼或脉络膜脱离——并使用调整后的回归模型评估手术特征和并发症的可能性。并发症分析按术后 90 天内第二只眼白内障手术分层。
我们确定了 457128 名接受第一只眼白内障手术的受益人，其中 23332 名（5.1%）患有痴呆症。在诊断为痴呆症的受益人中，没有一种评估的手术并发症更有可能发生。非卧床手术中心环境、麻醉提供者或术后住院治疗的可能性也没有差异。诊断为痴呆症的受益人的手术更有可能被编码为复杂手术（占病例的 15.6%，而 8.8%，P<0.0001），且手术时间超过 30 分钟（比值比=1.21，95%置信区间=1.17-1.25）。
在美国接受白内障手术的医疗保险受益人中，患有痴呆症的人更有可能进行“复杂”手术，手术时间超过 30 分钟。然而，他们发生手术并发症、更高风险环境、更先进的麻醉护理或术后住院治疗的可能性并没有增加。这可能是由于病例选择的影响，可能表明错过了改善视力的机会。需要进一步研究以确定可能从白内障手术中受益的痴呆症患者。
