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Endophthalmitis Rates among Medicare Beneficiaries Undergoing Cataract Surgery between 2011 and 2019

Published:September 16, 2021DOI:https://doi.org/10.1016/j.ophtha.2021.09.004

      Purpose

      To determine national incidence and risk factors associated with developing endophthalmitis after cataract surgery in the United States.

      Design

      Retrospective, cross-sectional analysis.

      Participants

      Medicare beneficiaries aged ≥65 years undergoing cataract surgery between 2011 and 2019.

      Methods

      Medicare claims were used to identify all patients who underwent ≥1 cataract surgery between 2011 and 2019. Endophthalmitis cases within 90 days of the cataract surgery were identified using diagnostic codes. Patients with a history of endophthalmitis 12 months before their cataract surgery procedure were excluded. Annual and aggregate 9-year incidences were determined for all cataract surgeries and for stand-alone cataract procedures. A stepwise multivariable logistic regression model using generalized estimating equations was used to evaluate factors associated with occurrence of postoperative endophthalmitis.

      Main Outcome Measures

      The 90-day postoperative endophthalmitis rate and patient risk factors associated with onset of endophthalmitis after cataract surgery.

      Results

      A total of 14 396 438 cataract surgeries were performed among Medicare beneficiaries between 2011 and 2019. The overall 90-day postoperative endophthalmitis rate was 1.36 per 1000 cataract surgeries for all cataract procedures and 1.30 per 1000 cataract surgeries for stand-alone cataract procedures. A decreasing trend was noted for postoperative endophthalmitis rates during the 9-year study period. On multivariable analysis, the risk of endophthalmitis after cataract surgery was increased for cases performed among those aged ≥75 years versus those aged <75 years (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.11–1.18), Blacks (OR, 1.13; 95% CI, 1.07–1.20), Native Americans (OR, 1.43; 95% CI, 1.19–1.73), and eyes with any history of invasive glaucoma surgery (OR, 1.40; 95% CI, 1.18–1.65). Cataract cases combined with retinal surgery (OR, 2.60; 95% CI, 2.15–3.16) and those performed when the Charlson Comorbidity Index (CCI) was greater than 0 also had an increased likelihood of developing endophthalmitis. The risk of endophthalmitis was lower for cases performed on women versus men (OR, 0.89; 95% CI, 0.86–0.92).

      Conclusions

      The overall 90-day postoperative endophthalmitis rate after cataract surgery was 1.36 per 1000 cataract surgeries between 2011 and 2019. Patient age, gender, race, and CCI were associated with risk of endophthalmitis.

      Keywords

      Abbreviations and Acronyms:

      ASC (ambulatory surgical center), CBSA (core-based statistical area), CCI (Charlson Comorbidity Index), CI (confidence interval), DM (diabetes mellitus), FIPS (Federal Information Processing Standard), ICD (International Classification of Diseases), ICD-9 (International Classification of Diseases 9th Revision), ICD-10 (International Classification of Diseases 10th Revision), MIGS (minimally invasive glaucoma surgery), OR (odds ratio)
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