Predictors of mortality within 90 days of cataract surgery

Purpose: To identify predictors of mortality within 90 days of cataract surgery.

Design: A retrospective cohort study.

Participants: 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.

Main outcome measures: 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.