You might suspect dementia patients are able to remain still and cooperate with instructions during surgery due to cognitive decline. You might also predict that these patients have a higher risk of complications during and after surgery. You would be wrong.
A recent study has noted that differences in surgical characteristics and outcomes may be fewer than commonly believed. Among Medicare beneficiaries who underwent cataract surgery between 2009 and 2016, those with dementia diagnoses did not have a higher risk of surgical complications or postoperative hospitalizations compared with their counterparts without the disorder.
In the study’s representative sample of Medicare beneficiaries, 457,128 patients underwent first-eye cataract surgery, 23,332 (5.1%) of whom had a dementia diagnosis. The patients with dementia were more likely to have surgeries coded as complex (15.6% vs. 8.8%) as well as have surgeries exceed 30 minutes. However, this group did not have a greater likelihood of surgical complications, higher-acuity setting, advanced anesthesia care or postoperative hospitalization.
The only complications often impacted by dementia status—specifically retinal tear, IOL subluxation/dislocation and cystoid macular edema—were paradoxically less likely among the dementia-diagnosed beneficiaries in this study.
The researchers suggested two possibilities that may impact their findings: (1) careful and appropriate patient selection to avoid surgery when risks outweigh benefits or (2) biased patient selection where dementia patients who could benefit from cataract surgery are not referred.
There might be missed opportunities to better serve dementia patients’ eye care needs, including cataract diagnosis and potential cataract surgery. Given the advanced state of current surgical technology and techniques, the study concluded that less hesitancy might be warranted in recommending surgery.
Pershing S, Henderson VW, Goldstein MK, et al. Cataract surgery complexity and surgical complication rates among Medicare beneficiaries with and without dementia. Am J Ophthalmol. August 20, 2020. [Epub ahead of print].