title: Comparison of complication rates in veterans receiving cataract surgery through the Veterans Health Administration and Medicare.
abstract: BACKGROUND
  To compare the 90-day rates of select secondary procedures after cataract extraction in patients having fee-for-service surgery under Medicare to surgeries provided through the Veterans Health Administration (VHA) during the same calendar year.
  
  
  METHODS
  Medicare, VHA, and VHA Fee Basis Program data for calendar year 2007 were merged to identify a cohort of veterans that had outpatient cataract surgery. Secondary surgeries were tracked using selected Current Procedural Terminology (CPT) codes as surrogate markers for complications. Primary surgery and corrective surgeries were linked through right and left eye CPT modifier codes. Risks of complications were adjusted for race, age, sex, and ocular and medical comorbidities.
  
  
  RESULTS
  A total of 223,873 cataract extractions were performed on veterans during calendar year 2007, 88.4% of which were provided through Medicare. The 90-day overall rate of CPT-coded secondary procedures was greater for patients having cataract surgery through the VHA (37.2 per 1000 surgeries) than Medicare (18.2 per 1000 surgeries). The overall rate was influenced primarily by higher rates of vitrectomy and related procedures, after both routine and complex cataract extractions. The adjusted odds ratio of vitrectomy within 90 days of routine cataract surgery in the VHA with reference to Medicare was 3.77 (95% confidence interval, 3.44-4.14).
  
  
  CONCLUSIONS
  In 2007, the pattern and rates of secondary surgeries after cataract extraction varied between the Medicare and the VHA programs. If these results are confirmed, further research to identify the sources of higher secondary procedure rates is warranted to enhance patient safety.
authors.affiliation: VA Center of Excellence on Implementing Evidence Based Practice, Regenstrief Institute Inc., USA. Dustin.French2@va.gov
authors.forename: Dustin D
authors.initials: DD
authors.lastname: French
authors.forename: Curtis E
authors.initials: CE
authors.lastname: Margo
authors.forename: Robert R
authors.initials: RR
authors.lastname: Campbell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures / Q000706:statistics & numerical data; D002387:Cataract Extraction / Q000009:adverse effects* / Q000706:statistics & numerical data*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D061214:Patient Safety / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology*; D011787:Quality of Health Care / Q000706:statistics & numerical data; D044469:Racial Groups / Q000706:statistics & numerical data; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*