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Sophia Ying Wang, Taylor Blachley, John Ayanian, Paul P Lee, Joshua D Stein; Determinants of hospitalization after cataract surgery in a large managed-care United States population. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5576.
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Because little is known regarding the extent to which patients undergoing outpatient cataract surgery are at risk for requiring post-operative hospitalization, we sought to determine the proportion of patients undergoing cataract surgery who require subsequent inpatient hospitalization during the immediate post-operative period and to identify risk factors for hospitalization.
We identified all beneficiaries age ≥40 years old in a U.S. managed care network who underwent ≥1 cataract surgeries from 2001-2011. Next, we identified all enrollees who required inpatient hospitalization within 7, 14, 30, and 90 days following their initial cataract surgery. Logistic regression was performed to identify sociodemographic factors, medical comorbidities, and other factors that increased the odds of requiring hospitalization following cataract surgery.
Among the 72,160 persons who underwent cataract surgery, the proportions hospitalized within 7, 14, 30, and 90 days after surgery were 0.3%, 0.6%, 1.3%, and 4.1%, respectively. Among the subset of 11,795 persons who went into the surgery with no major medical comorbidities, the proportions hospitalized within 7, 14, 30, and 90 days were 0.12%, 0.22%, 0.45%, and 1.42%, respectively, or roughly one third the rate. Enrollees with a prior history of congestive heart failure, myocardial infarction, and renal disease had a 46%, 49%, and 62% increased odds of hospitalization within 7 days, relative to those without these conditions (p<0.05 for all conditions). Patients with dementia had a 117% increased odds of hospitalization (p<0.01). The odds of hospitalization increased by 39% with the presence of each additional comorbidity (p<0.0001). Those with ≥1 prior inpatient hospitalizations had a 124% increased odds of hospitalization within 7 days of cataract surgery (p<0.0001).
The risk of hospitalization after cataract surgery is low, and is very low among those with no major pre-existing medical comorbidities. Opportunities may exist to reduce overall healthcare costs without adversely impacting patient safety by limiting the need for comprehensive preoperative evaluation and testing to those who have serious pre-existing medical comorbidities.
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