Vitrectomy and All-Cause and Cause-Specific Mortality in Elderly Patients With Vitreoretinal Diseases: A Nationwide Cohort Study

Abstract

PurposeTo determine the all-cause and cause-specific mortality in elderly patients with vitreoretinal diseases based on vitrectomy status.MethodsElderly patients (aged ≥ 60 years) diagnosed with vitreoretinal diseases between 2003 and 2012 using the Korean National Health Insurance Service-Senior cohort (2002–2015) were included in this nationwide population-based retrospective cohort study. The exposure of interest was vitrectomy, and information on mortality from patient inclusion until December 2015 was obtained. Cox regression modeling was used to assess the association between vitrectomy and mortality. An additional subgroup analysis was performed to investigate the effects of the underlying retinal disease characteristics and comorbidities on mortality.ResultsThe study cohort included 152,283 patients (3,313 and 148,970 in the vitrectomy and non-vitrectomy groups, respectively). The adjusted model showed vitrectomy was associated with a decreased risk of pulmonary-cause mortality [hazard ratio (HR), 0.51; P < 0.001]; however, no association was observed for all-cause mortality (HR, 0.93; P = 0.325). Vitrectomy was associated with increased mortality risk (all-cause: HR, 1.26; P < 0.001 and vascular causes: HR, 1.41; P = 0.003) among patients with retinal vascular diseases and decreased mortality risk (all-cause: HR, 0.64; P < 0.001 and pulmonary causes: HR, 0.35; P = 0.011) among patients with macular diseases. There were significant interactions between age and vitrectomy with respect to all-cause mortality among patients with either vitreoretinal disease.ConclusionsIn elderly patients with retinal diseases, the vitrectomy group showed the lower mortality from pulmonary causes with no association for all-cause mortality.

Association of retinopathy with risk of all-cause and specific-cause mortality in the National Health and Nutrition Examination Survey, 2005 to 2008

“…(39) Similarly, Kim et al did not detect a correlation between vitreoretinal disease and cancer mortality in the older adults. (50) Given the convenience of obtaining the diagnosis and grading of retinopathy by fundus examination in a non-invasive manner, the findings of our study have several practical implications. Firstly, our current study found that the diagnosis of retinopathy was an independent risk factor for all-cause mortality in people over 40 years, suggesting that the general older adults population may benefit from a routine fundus examination program.…”

“…( 39 ) Similarly, Kim et al did not detect a correlation between vitreoretinal disease and cancer mortality in the older adults. ( 50 )…”