Predictors of mortality within 90 days of cataract surgery.
OBJECTIVE
To identify predictors of mortality within 90 days of cataract surgery.


METHODS
A retrospective cohort study.


METHODS
A total of 45,082 patients who underwent cataract surgery in the Veterans Health Administration (VHA) between October 1, 2005 and September 30, 2007.


METHODS
The National Patient (US) Care Database (NPCD) was used to identify all patients who underwent outpatient extracapsular cataract surgery performed in the VHA and who had only 1 cataract surgery within 90 days of the index surgery. Data collected includes demographics, number of hospitalizations within 1 year before surgery, postoperative mortality, and systemic comorbidities using the Charlson Comorbidity Index (CCI), which predicts the 1-year mortality for a patient based on a range of co-morbid conditions scored 1, 2, 3 or 6 depending on the risk of dying associated with the condition. Adjusted odds ratios (OR) of factors predictive of 90-day mortality were calculated using logistical regression modeling.


METHODS
Mortality within 90 days of cataract surgery.


RESULTS
Of the 53,786 patients who underwent cataract surgery during the study period, 45,082 met inclusion criteria. Mean age was 71.8 years; 97.6% were men; 5.0% had complex cataract surgery. The most frequent systemic comorbidities in the CCI were diabetes mellitus (40.6%), chronic pulmonary disease (21.2%), malignant neoplasms (12.5%) and congestive heart failure (CHF; 9.5%). Patients had a median CCI score of 1; 43.7% had a score ≥ 2. Mortality rate within 90 days after cataract surgery was 7.1 per 1000 patients. Independent predictors of 90-day postoperative mortality were [adjusted OR, (95% confidence interval; CI)]: age 80 or greater [2.54 (1.62, 3.98)], CCI ≥ 2 [2.06 (1.58, 2.70)], ≥ 1 hospitalizations in the past year [1.85 (1.45, 2.36)], chronic pulmonary disease (CPD) [1.69 (1.34, 2.14)], CHF [1.71 (1.29, 2.14)], cirrhosis [2.60 (1.31, 5.15)], multiple myeloma or leukemia [2.20 (1.07, 4.53)], and metastatic solid tumor [4.17 (1.80, 9.66)].


CONCLUSIONS
The risk of 90-day mortality after cataract surgery is low, even for patients at higher risk for mortality such as the elderly and those with a high preoperative disease burden.
Greenberg
Paul B
PB
Section of Ophthalmology, VA Medical Center, Providence, Rhode Island 02908, USA. paul_greenberg@brown.edu
Liu
Jeffrey
J
Wu
Wen-Chih
WC
Jiang
Lan
L
Tseng
Victoria L
VL
Scott
Ingrid U
IU
Friedmann
Peter D
PD
D000368:Aged; D000369:Aged, 80 and over; D002387:Cataract Extraction / Q000401:mortality*; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006787:Hospitals, Veterans / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data