Abstract
Purpose
Cataract surgery is the most common surgical procedure in the United States and can be coded as routine or complex, with the latter defined as employing devices or techniques not routinely employed in routine surgery, elevating risk of adverse outcomes. The study aimed to determine whether socioeconomic factors are associated with the need for complex cataract surgery after controlling for known clinical factors associated with routine versus complex surgery.Methods
Patients 18 years of age and over in the Sight Outcomes and Reseach Collaborative with one or more cataract surgeries across 16 U.S. medical centers from 2010 to 2023. Multivariable logistic regression models were used, with the first model examining key covariates and the first eye or cataract surgery, and the second model examining covariates on the second eye (bilateral) or cataract surgery, if applicable, while accounting for the first eye (as routine or complex).Results
Factors associated with increased odds of complex surgery in both the first and second procedures were male sex, increasing age, worse vision, increased cataract density, Black and Asian race, diabetes, pseudoexfoliation syndrome, intraoperative floppy iris syndrome, and the use of alpha-1 blockers and miotic agents. Additionally, receipt of complex surgery in the second eye (bilateral) was significantly associated with increased odds if the first eye was also a complex surgery.Conclusions
Several socioeconomic factors remained significant after adjusting for known clinical factors associated with complex cataract surgery. Findings may inform the development of enhanced risk assessment to identify patients at elevated risk for complex surgery.