Health care utilization for injury in cataract surgery patients.
BACKGROUND
Although visual impairment has been associated with falls, fractures, and other injuries, the relation between cataract surgery and injuries is unclear. This study assesses whether persons waiting for cataract surgery are at increased risk of requiring health care services for an injury compared with a control group, and, if so, whether the risk changes after cataract surgery.


METHODS
This is a retrospective case-control study of first-eye cataract surgery recipients in Manitoba in fiscal 1999-2000. Health care administrative data and cataract waiting list registry data were the data sources. Cataract surgery recipients were matched 3:1 with controls on age, sex, and region. The outcome measure was a diagnosis of injury identified using International Classification of Diseases 9 (Clinical Modification) codes in the physician or hospital claims. Data were analyzed for 2 years before and after cataract surgery. A multivariate logistic regression adjusted for potential confounders, such as burden of illness, presence of diabetes, stroke or dementia, number of different medications, and use of psychoactive mediations.


RESULTS
There were 3811 cases and 11,359 controls. Cases were found to be much more likely to have a history of stroke, diabetes, or dementia, and were more likely to have been prescribed multiple medications or a psychoactive drug. After adjustment for comorbidities and pharmaceutical use, cases had a significantly higher probability of an injury before surgery (0.2784 vs. 0.2538; chi2 = 5.01, p = 0.03). This decreased significantly after surgery to 0.2333 (chi2 = 18.05, p < 0.0001). After surgery, the adjusted probability of injury was lower among cases (0.2333) than controls (0.2385), though this was not significant. The adjusted odds ratio for having an injury was 1.032 (95% confidence interval 1.026, 1.039) per week of waiting.


CONCLUSIONS
Cataract patients have a significantly increased risk of injury compared with controls before surgery, but their risk decreases to that of controls following surgery. Given that cataract patients also bear a much heavier burden of illness, including conditions that are associated with a higher risk of falls and injuries, the imperative of performing cataract surgery without delay becomes even more pressing.
De Coster
Carolyn
C
Quality, Safety and Health Information, Calgary Health Region, Alta. Carolyn.DeCoster@calgaryhealthregion.ca
Dik
Natalia
N
Bellan
Lorne
L
D000058:Accidental Falls; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002386:Cataract / Q000150:complications*; D002387:Cataract Extraction; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D014786:Vision Disorders / Q000209:etiology / Q000628:therapy*; D014850:Waiting Lists; D014947:Wounds and Injuries / Q000209:etiology / Q000628:therapy*