title: Short-term mortality following cataract surgery: comparison of Veterans Health Administration and Medicare outcomes.
abstract: OBJECTIVE
  To compare short-term risk of death following cataract surgery in veterans having surgery in the Veterans Health Administration (VHA) and through Medicare.
  
  
  METHODS
  Medicare and VHA databases were merged to identify a cohort of veterans (N = 149,023) that had outpatient cataract surgery during 2007. National mortality sources were used to ascertain vital statistics. A Cox regression model estimated hazard ratios for routine and complex cataract extractions.
  
  
  RESULTS
  Ninety days after cataract surgery the rates of death were 0.80% for patients in Medicare and 0.70% for beneficiaries in the VHA (P > 0.05). There was no difference in death hazard 6 months following surgery, after adjusting for age, race, gender, and medical comorbidities. Significant Medicare hazard ratio (HR) was seen at one year with routine cataract extraction (HR 1.17, 95% confidence interval, CI, 1.09-1.27), and with complex cataract extraction (HR 1.17, 95% CI 1.08-1.27).
  
  
  CONCLUSIONS
  The 6-month risk of death after cataract surgery is low, and does not differ among veterans whose surgery was performed in the VHA or through Medicare. If confirmed, excess postoperative mortality at one year in Medicare needs to be studied through more direct methodologies.
authors.affiliation: VA Center of Excellence on Implementing Evidence Based Practice, Regenstrief Institute Inc., Department of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, Indiana 46202, 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
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002387:Cataract Extraction / Q000401:mortality*; D002423:Cause of Death; D005260:Female; D006801:Humans; D019654:Lens Implantation, Intraocular; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D011183:Postoperative Complications; D016016:Proportional Hazards Models; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*