Adverse events after pars plana vitrectomy among medicare beneficiaries.
OBJECTIVE
To assess the complication rates of pars plana vitrectomy (PPV) among older Americans and to determine whether rates of adverse events and additional operations have changed during the past decade.


METHODS
Claims data were reviewed to identify all adults aged 68 years or older in the 5% Medicare sample who underwent their first PPV during 1994-1995, 1999-2000, and 2004-2005. One-year rates of severe complications (endophthalmitis, suprachoroidal hemorrhage, or retinal detachment), less severe complications, receipt of an additional operation, and blindness were calculated and compared among the 3 groups using Cox regression. Analyses were adjusted for prior adverse events (during the previous 3 years), demographic characteristics, and comorbid conditions.


RESULTS
The 1994-1995, 1999-2000, and 2004-2005 cohorts had 3263, 5064, and 5263 patients, respectively. The 1-year severe complication rates did not differ among the 3 groups (range, 4.8%-5.5%). The hazard of a less severe complication or an additional operation was higher in the 2004-2005 cohort than in the earlier cohorts (P < .05 for all comparisons). The hazard of endophthalmitis was higher in black individuals (P = .07) and those of other races (P = .02) than in white patients.


CONCLUSIONS
During the past decade, rates of severe complications after PPV remained stable, but rates of less severe complications and subsequent operations increased. Future studies should explore the potential factors that explain these changes and the alarming elevated incidence of post-PPV endophthalmitis among nonwhite individuals.
Stein
Joshua D
JD
Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall St, Ann Arbor, MI 48105, USA. jdstein@med.umich.edu
Zacks
David N
DN
Grossman
Daniel
D
Grabe
Hilary
H
Johnson
Mark W
MW
Sloan
Frank A
FA
D000368:Aged; D000369:Aged, 80 and over; D002832:Choroid Hemorrhage / Q000453:epidemiology / Q000209:etiology; D009877:Endophthalmitis / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006302:Health Services Research; D006801:Humans; D015994:Incidence; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D011183:Postoperative Complications; D016016:Proportional Hazards Models; D012163:Retinal Detachment / Q000453:epidemiology / Q000209:etiology; D014481:United States / Q000453:epidemiology; D014821:Vitrectomy / Q000009:adverse effects*