Elsevier

Ophthalmology

Volume 129, Issue 3, March 2022, Pages 250-257
Ophthalmology

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

https://doi.org/10.1016/j.ophtha.2021.09.004Get rights and content

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.

Section snippets

Study Population

This was a retrospective, cross-sectional analysis of the 2011–2019 100% Medicare fee-for-service claims accessed via Centers for Medicare and Medicaid Services Virtual Research Data Center. We identified all patients who underwent at least 1 cataract surgery between 2011 and 2019 using Current Procedural Terminology codes (66982, 66983, 66984, 66850, 66920, 66930, and 66940). We excluded patients without 12 months continuous enrollment in Medicare Parts A and B before their cataract surgery

Study Population Demographics

A total of 14 396 438 cataract surgeries were performed among Medicare beneficiaries between 2011 and 2019 (Fig S1, available at www.aaojournal.org). Most procedures performed were among patients aged 65 to 74 years (52.1%), women (60.1%), and Whites (87.8%) (Table 1). Approximately 69% of cases performed were in ASCs, with ASC use increasing from 63.1% in 2011 to 74.9% in 2019. Most cataract cases (97%) were stand-alone procedures. A small proportion of combined cataract cases had more than 1

Discussion

In our analysis of more than 14 million cataract surgeries performed between 2011 and 2019, the overall endophthalmitis rate within 90 days of the cataract surgery was 1.36 per 1000 cataract surgeries. A declining trend in postoperative endophthalmitis rates was observed across all races/ethnicities during the 9-year study period. Patient gender, race, comorbidity burden, and history of glaucoma surgery were found to influence the risk of developing endophthalmitis. We also found significant

References (44)

  • S. Pershing et al.

    Endophthalmitis after cataract surgery in the United States: a report from the Intelligent Research in Sight Registry, 2013-2017

    Ophthalmology

    (2020)
  • S.G. Schwartz et al.

    Intracameral antibiotics and cataract surgery: endophthalmitis rates, costs, and stewardship

    Ophthalmology

    (2016)
  • M.E. Charlson et al.

    A new method of classifying prognostic comorbidity in longitudinal studies: development and validation

    J Chronic Diseases

    (1987)
  • J.D. Stein et al.

    Severe adverse events after cataract surgery among Medicare beneficiaries

    Ophthalmology

    (2011)
  • D.T. Du et al.

    Incidence of endophthalmitis after corneal transplant or cataract surgery in a Medicare population

    Ophthalmology

    (2014)
  • M.F. Chiang et al.

    The 2016 American Academy of Ophthalmology IRIS® Registry (Intelligent Research In Sight) database: characteristics and methods

    Ophthalmology

    (2018)
  • S. Zafar et al.

    Billing of cataract surgery as complex versus routine for Medicare beneficiaries

    J Cataract Refract Surg

    (2019)
  • T. Rutar et al.

    Risk factors for intraoperative complications in resident-performed phacoemulsification surgery

    Ophthalmology

    (2009)
  • D.F. Chang et al.

    Antibiotic prophylaxis of postoperative endophthalmitis after cataract surgery: results of the 2014 ASCRS member survey

    J Cataract Refract Surg

    (2015)
  • N.H. Shorstein et al.

    Decreased postoperative endophthalmitis rate after institution of intracameral antibiotics in a Northern California eye department

    J Cataract Refract Surg

    (2013)
  • S. Zafar et al.

    Risk factors for repeat keratoplasty after endothelial keratoplasty in the Medicare population

    Am J Ophthalmol

    (2021)
  • A.M. Morris et al.

    Racial disparities in late survival after rectal cancer surgery

    J Am Coll Surg

    (2006)
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    Supplemental material available at www.aaojournal.org.

    Disclosure(s):

    All authors have completed and submitted the ICMJE disclosures form.

    The author(s) have no proprietary or commercial interest in any materials discussed in this article.

    HUMAN SUBJECTS: Human subjects were included in this study. The human ethics committees at the Johns Hopkins University School of Medicine approved the study. This was a retrospective study using de-identified Medicare data, informed consent was not possible. All research adhered to the tenets of the Declaration of Helsinki.

    No animal subjects were used in this study.

    Author Contributions:

    Conception and design: Zafar, Dun, Srikumaran, Wang, Schein, Makary, Woreta

    Data collection: Dun, Wang, Makary

    Analysis and interpretation: Zafar, Dun, Srikumaran, Schein, Makary, Woreta

    Obtained funding: N/A

    Overall responsibility: Zafar, Dun, Srikumaran, Wang, Schein, Makary, Woreta

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