Cataract Surgery in dementia patients complex but without complications, claims study

The findings have been published in the American Journal of Ophthalmology.

Dementia, an umbrella term referring to a wide range of symptoms of cognitive decline, impairment in memory, communication, and thinking, has been on a global rise in the aging population.

Cataract surgery is one of the most frequent geriatric surgical procedures performed nationally. It is generally recognized as highly safe and effective, is usually performed as a same-day outpatient procedure.

Studies have previously shown that patients are less likely to receive cataract surgery if they have a dementia diagnosis, even among the subset of patients who are seen by an ophthalmologist. Cataract surgery may be more difficult in the setting of dementia, and patients, caregivers, and providers may be more likely to hesitate for surgery—due to logistical challenges in coordinating surgery as well as concerns such as postoperative care requirements and risk of complications.

However, there is to date, a scarcity of data on whether there is a difference in cataract surgical characteristics or complication rates based on dementia status.

To bridge this existing gap, Suzann Pershing and associates at the Byers Eye Institute at Stanford, undertook a study to evaluate cataract surgery complexity and complications among US Medicare beneficiaries with and without dementia.

The study design was a retrospective claims-based cohort study with Participants(aged 65 years and older) including a 20% representative sample of Medicare beneficiaries from 2006-2015. Further, researchers limited the study sample to only consider first-eye cataract surgeries.

For each surgery, the team determined (1) surgical complexity as determined by CPT code (2) site of service in ambulatory surgery center (ASC)  or hospital outpatient department (HOPD), (3) anesthesia provider type (anesthesiologist and/or certified registered nurse anesthetist (CRNA)), (4) duration of surgery based on anesthesia time claims, and (5) incidence of same or next day inpatient hospitalization after surgery. ICD-9 codes were used to identify surgical complications i. e. return to the operating room, endophthalmitis, suprachoroidal hemorrhage, retinal detachment, retinal tear, macular edema, glaucoma, or choroidal detachment, occurring within 30- and 90-days after cataract surgery.

The results highlighted the following facts.

• 457,128 beneficiaries undergoing first-eye cataract surgery were identified , 23,332 (5.1%) with dementia.
• None of the evaluated surgical complications were more likely in dementia-diagnosed beneficiaries.
• There was also no difference in the likelihood of nonambulatory surgery center setting, anesthesiologist provider, or postoperative hospitalization.
• Dementia-diagnosed beneficiaries were more likely to have surgeries coded as complex (15.6% of cases versus 8.8%, p<0.0001), and surgeries exceeding 30 minutes (OR=1.21, 95%CI=1.17-1.25). > < 0.0001), and surgeries exceeding 30 minutes (OR=1.21, 95%CI=1.17-1.25).

"Although further research is needed, there is robust evidence that cataract surgery has value in the setting of dementia. Already shown to improve quality of life and reduce rates of fractures in the general population, there is evidence to support additional benefits among dementia patients—including reduced rates of depression and potentially improved cognitive trajectory outcomes, particularly improvement in the rate of decline of episodic memory scores. Combined with no apparent difference in risk of complications, these findings suggest that providers should more frequently consider offering cataract surgery to dementia patients. "the authors concluded.

Primary source: American Journal of Ophthalmology

For the full article click on the link: https://doi.org/10.1016/j.ajo.2020.08.025