Severe adverse events after cataract surgery among medicare beneficiaries

Purpose: To determine rates and risk factors associated with severe postoperative complications after cataract surgery and whether they have been changing over the past decade. Design: Retrospective longitudinal cohort study. Participants: A total of 221 594 Medicare beneficiaries who underwent cataract surgery during 19942006. Methods: Beneficiaries were stratified into 3 cohorts: those who underwent initial cataract surgery during 19941995, 19992000, or 20052006. One-year rates of postoperative severe adverse events (endophthalmitis, suprachoroidal hemorrhage, retinal detachment) were determined for each cohort. Cox regression analyses determined the hazard of developing severe adverse events for each cohort with adjustment for demographic factors, ocular and medical conditions, and surgeon case-mix. Main Outcome Measures: Time period rates of development of severe postoperative adverse events. Results: Among the 221 594 individuals who underwent cataract surgery, 0.5% (1086) had at least 1 severe postoperative complication. After adjustment for confounders, individuals who underwent cataract surgery during 19941995 had a 21% increased hazard of being diagnosed with a severe postoperative complication (hazard ratio [HR] 1.21; 95% confidence interval [CI], 1.051.41) relative to individuals who underwent cataract surgery during 20052006. Those who underwent cataract surgery during 19992000 had a 20% increased hazard of experiencing a severe complication (HR 1.20; 95% CI, 1.041.39) relative to the 20052006 cohort. Risk factors associated with severe adverse events include a prior diagnosis of proliferative diabetic retinopathy (HR 1.62; 95% CI, 1.072.45) and cataract surgery combined with another intraocular surgical procedure on the same day (HR 2.51; 95% CI, 2.073.04). Individuals receiving surgery by surgeons with the case-mix least prone to developing a severe adverse event (HR 0.52; 95% CI, 0.440.62) had a 48% reduced hazard of a severe adverse event relative to recipients of cataract surgery performed by surgeons with the case-mix most prone to developing such outcomes. Conclusions: Rates of sight-threatening adverse events after cataract surgery declined during 19942006. Future efforts should be directed to identifying ways to reduce severe adverse events in high-risk groups. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.