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Victoria Tseng, JoAnn Giaconi, Fei Yu, Anne Coleman; Cataract Surgery, Fractures, and Fracture-Related Mortality in the Veterans Health Administration. Invest. Ophthalmol. Vis. Sci. 2017;58(8):764.
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Cataract surgery has been proposed as a potential intervention to reduce fracture and mortality risk in the elderly population. The purpose of this study was to examine the associations between cataract surgery, fractures, and fracture-related mortality in the Veterans Health Administration (VHA).
This retrospective cohort study included all veterans with a diagnosis code for cataract between 2002 and 2012 in the national administrative VHA database. The exposure of interest was cataract surgery. The outcomes of interest included the occurrences of any fracture, hip fracture, and mortality at any time between cataract diagnosis or surgery and the end of the study period. Covariates included demographics, systemic comorbidities in the Charlson Comorbidity Index, ocular comorbidities, and additional systemic conditions associated with increased fracture risk. Cox proportional hazards regression was used to examine the associations between cataract surgery and any fractures and hip fractures in the study population. Cox models were also used to conduct stratified analyses of the associations between cataract surgery and mortality in patients with and without a history of fracture. All models were adjusted for all study covariates.
There were 1,917,412 veterans in the study population, of whom 300,683 (15.7%) had cataract surgery. The incidence of any fracture was 2.6 fractures/100 person-years in the cataract surgery group and 1.7 fractures/100 person-years in the cataract diagnosis group. Cataract surgery was associated with increased adjusted risks of any fracture (hazards ratio [HR]=1.31, 95% CI=1.29, 1.33) and of hip fracture (HR=1.33, 95% CI=1.28, 1.38). Cataract surgery was associated with decreased adjusted risks of mortality both in patients with a history of fractures (HR=0.73, 95% CI=0.71, 0.75) and in patients without a history of fractures (HR=0.70, 95% CI=0.70, 0.71).
In VHA patients with cataract, cataract surgery is associated with increased fracture risk but decreased mortality risk both in patients with and without a history of fracture. Further studies are needed to understand the mechanisms of association between cataract surgery, fractures, and mortality in the VHA population.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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