Early Endophthalmitis Incidence and Risk Factors Following Glaucoma Surgery in the Medicare Population From 2016 to 2019
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An analysis of a large Medicare population database showed an increased incidence of endophthalmitis after glaucoma surgery alone (1.5 per 1000 surgeries) versus cataract surgery alone (0.8 per 1000 surgeries). Endophthalmitis was diagnosed at a median of 16.5 days after standalone glaucoma surgery, 8 days after combined cataract and glaucoma surgeries, and 6 days after cataract surgery alone. In patients who underwent glaucoma surgery, the risk of endophthalmitis was increased for those who received tube shunt surgeries as well as for older patients, men, and those with medical comorbidities.
- These findings will help inform clinicians regarding the surgical risk of endophthalmitis after glaucoma surgeries.
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersOBJECTIVE
To determine early endophthalmitis incidence and risk factors following glaucoma surgeries in the Medicare population.
DESIGN
Retrospective, longitudinal study.
SUBJECTS AND PARTICIPANTS
Eyes that had glaucoma surgery among Medicare Fee-For-Service and Medicare Advantage beneficiaries in the US aged 65 years or older.
METHODS
Medicare Fee-For-Service and Medicare Advantage claims were used to identify all patients who underwent glaucoma surgery, combined cataract/glaucoma surgery, and cataract surgery alone from 2016 to 2019. Endophthalmitis cases within 42 days of the index surgery were identified using the International Classification of Diseases, Tenth Revision-Clinical Modification (ICD-10 CM) codes. Multivariable logistic regression models were used to evaluate factors associated with postoperative endophthalmitis.
MAIN OUTCOME MEASURES
The 42-day postoperative endophthalmitis incidence and risk factors associated with endophthalmitis following glaucoma surgery.
RESULTS
There were 466,928 glaucoma surgeries, of which 310,823 (66.6%) were combined with cataract surgery. Cataract surgeries alone (n=8,460,360) served as a reference group. Microinvasive glaucoma surgeries constituted most glaucoma procedures performed (67.8%), followed by trabeculectomy (14.0%), tube shunt (10.9%), and Other procedures (7.3%). There were 572 cases of endophthalmitis identified following all glaucoma surgeries. Endophthalmitis incidence following glaucoma, combined cataract/glaucoma, and cataract surgeries alone were 1.5 (95% confidence interval [CI]; 1.3-1.7), 1.1 (95% CI; 1.0-1.2), and 0.8 (95% CI; 0.8-0.8) per thousand procedures, respectively. The median day of diagnosis of endophthalmitis was later for glaucoma surgeries at 16.5 days compared to combined cataract/glaucoma or cataract surgeries alone at 8 and 6 days, respectively. Compared to MIGS, Tube shunts were the only surgery type to be a significant risk factor for endophthalmitis for both standalone (aOR 1.8, p=0.002) and combined surgery (aOR 1.8, p=0.047). The other risk factor for both standalone (aOR 1.1, p=0.001) and combined (aOR 1.06, p=0.049) was Charlson comorbidity index (CCI). Age (aOR 1.03, p=0.004) and male gender (1.46, p=0.001) were significant risk factors only for combined cataract and glaucoma surgeries.
CONCLUSIONS
Compared to cataract surgery alone, early endophthalmitis incidence was higher for both glaucoma surgeries and combined cataract/glaucoma surgeries, with the highest incidence among tube shunts. There were differing demographic risk factors for combined cataract/glaucoma surgeries compared to glaucoma surgeries alone.
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Additional Info
Disclosure statements are available on the authors' profiles:
Early Endophthalmitis Incidence and Risk Factors Following Glaucoma Surgery in the Medicare Population from 2016 to 2019
Ophthalmology 2023 Sep 12;[EPub Ahead of Print], J Sabharwal, X Dai, C Dun, A Chen, M Ali, OD Schein, PY Ramulu, M Makary, TV Johnson, F WoretaFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
In order to "determine early endophthalmitis incidence and risk factors following glaucoma surgeries in the Medicare population," the authors queried the Medicare Fee-For-Service and Medicare Advantage databases. They included microinvasive glaucoma surgeries (MIGS) as one of the glaucoma surgery types. They concluded that, "compared with cataract surgery alone, early endophthalmitis incidence was higher for both glaucoma surgeries and combined cataract and glaucoma surgeries, with the highest incidence for tube shunt surgeries." Specifically, "in this large-scale analysis, the overall 42-day endophthalmitis incidence rate for all glaucoma surgeries was 50% higher than that for cataract surgeries alone (1.2 per 1000 surgeries vs 0.8 per 1000 surgeries)." Moreover, "the incidence rate of endophthalmitis was higher for glaucoma surgeries alone than that for combined cataract and glaucoma surgeries, at 1.5 per 1000 surgeries and 1.1 per 1000 surgeries, respectively." Tube shunt surgeries resulted in the highest incidence of endophthalmitis. The factors that may have contributed to these findings are discussed. The implications for patients undergoing MIGS are also discussed. Given that the major risk factors for endophthalmitis identified in this study were increasing age, medical comorbidity, and male gender, this paper presents little that surgeons can modify, except for the recommendations regarding the timing of performing bilateral MIGS. Clearly, more research is needed on this topic.