Are routine preoperative medical tests needed with cataract surgery?

Lira, Rodrigo Pessoa Cavalcanti; Nascimento, Maurício Abujamra; Moreira-Filho, Djalma C.; Kara‐José, Newton; Arieta, Carlos Eduardo Leite

doi:10.1590/s1020-49892001000700003

Cited by 34 publications

(50 citation statements)

References 20 publications

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“…26 Hypertension, a minor outcome, was the most common adverse event in the current study. Although previous studies 14, 18 have also described perioperative hypertension as the most common outcome in cataract surgery, its incidence was higher in our sample. This can be explained by two reasons: patients in developing countries have worse access to health care and consequently poorer control of their disease; and the criteria of hypertension, in which the presence of one measure systolic pressure ≥ 180 mm Hg or dyastolic pressure ≥ 110 mm Hg, even if transient was considered hypertension.…”

Section: Discussioncontrasting

confidence: 80%

“…On the basis of an expected incidence of total adverse events of 9% in the non-evaluated group, a sample size of 884 patients (221 in the evaluated group and 663 in the non-evaluated group) would be necessary to detect a difference as small as 2% (7% in the evaluated group), with a power of 80% and a significance level of 5%. 18,19 Sample size was calculated using WinPepi software, version 11.43. 20 …”

Section: Outcome Measures and Sample Sizementioning

confidence: 99%

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The impact of preoperative evaluation on perioperative events in patients undergoing cataract surgery: a cohort study

Alboim

Kliemann

Soares

et al. 2016

Eye

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Purpose Ambulatory surgery is a major area of surgical and anesthetic practice, and preoperative clinics are being increasingly used for low-risk surgical procedures. This study investigated the impact of preoperative evaluation on perioperative events in patients undergoing cataract surgery. Methods This was a retrospective cohort study of 968 consecutive patients undergoing cataract surgery. Details of medical conditions, surgical, anesthetic, and postoperative information were collected from medical records. A logistic regression model was developed using propensity score adjustment for baseline characteristics. Results Out 968 patients included, 240 (24.7%) underwent outpatient preoperative evaluation. There were no perioperative major cardiovascular events. Hypertension occurred in 319 (33%) patients, accounting for 79.7% of all adverse events. Preoperative evaluation resulted in a lower hypertension rate after adjustment for propensity score (OR = 0.6; 95% CI 0.41-0.93); no effects were observed on posterior capsule rupture and emergency visits/hospitalization within 7 days of surgery. Eighty-nine patients (9.3%) had an initial systolic pressure ≥ 180 mm Hg, which was not associated with higher risk of posterior capsule rupture (P = 0.158) or postoperative adverse events (P = 0.902). Median waiting time to surgery was 6 and 2 months for evaluated and non-evaluated patients, respectively (Po0.001). Conclusions In the context of low-risk surgery and no major perioperative and postoperative outcomes, it appears that outpatient preoperative evaluation has no role in reducing adverse events in cataract surgery candidates. Despite fewer hypertensive episodes observed in evaluated patients, these episodes were not associated with any medical or surgical outcomes.

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Section: Discussioncontrasting

confidence: 80%

Section: Outcome Measures and Sample Sizementioning

confidence: 99%

The impact of preoperative evaluation on perioperative events in patients undergoing cataract surgery: a cohort study

Alboim

Kliemann

Soares

et al. 2016

Eye

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“…15,16 A própria rotina de requisição indiscriminada de exames é questionável, havendo evidências de que a requisição seletiva dos testes seria uma conduta mais racional. 10,16 Não há um consenso em relação a um protocolo de exames médicos para procedimentos ambulatoriais de curta duração sob anestesia local em pacientes oftalmológicos. Alguns autores mostraram variação substancial nos testes solicitados por oftalmologistas, anestesiologistas e clínicos.…”

Section: Discussionunclassified

“…12 Pacientes com eletrocardiograma alterado apresentaram mais complicações clínicas. Tal fato talvez se justifique em razão da principal complicação neste e em outros estudos 10 ter sido hipertensão arterial, patologia na qual são muito prevalentes as alterações no traçado eletrocardiográfico. 7 O presente estudo tem algumas limitações.…”

Section: Discussionunclassified

“…17 Hipertensão arterial, broncoespasmo e arritmia são responsáveis por mais de 90% dos intercorrências clínicas intra-operatórias em facectomias, e testes rotineiros parecem não prevê-las. 10,16 O presente estudo prospectivo tem por objetivos determinar a prevalência de resultados anormais numa rotina de testes médicos pré-operatórios. Pretende verificar também se os mesmos influenciam na ocorrência de complicações clínicas perioperatórias, numa população de pacientes adultos, candidatos à facectomia sob anestesia local, em um centro médico acadêmico.…”

Section: Introductionunclassified

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Valor preditivo de exames pré-operatórios em facectomias

et al. 2003

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DescritoresExtração de catarata. Testes diagnósticos de rotina. Cuidados pré-operatórios. Keywords Cataract extraction. Diagnostic tests, routine. Preoperative care. ResumoObjetivo Determinar a prevalência de resultados anormais numa rotina de exames pré-operatórios para facectomias e sua influência na ocorrência de complicações clínicas perioperatórias. Métodos Estudo prospectivo desenvolvido em um centro médico acadêmico no Brasil, com uma amostra de 746 pacientes, selecionados entre indicados para cirurgia de catarata. Para todos os pacientes foram solicitados eletrocardiograma, hemograma completo e glicemia de jejum, além de uma avaliação clínica. Foram excluídos do estudo pacientes com menos de 40 anos de idade, pacientes submetidos previamente à cirurgia ocular, pacientes com indicação de anestesia geral, ou pacientes que sofreram infarto agudo do miocárdio até três meses antes da cirurgia. Eventos médicos intra-operatórios foram registrados numa ficha de protocolo. Para análise, utilizou-se do teste de Fisher e análise de variância (ANOVA). Resultados Na amostra de 746 pacientes, 405 (54,3%) eram homens. A idade média foi de 66,6±11,6 anos. Ocorreram complicações intra-operatórias em 71 (9,5%) pacientes. Houve resultados anormais em 13,5% (101 pacientes) das dosagens de hemoglobina e em 16,6% (124) das dosagens de glicemia de jejum. Em relação aos eletrocardiogramas, foram constatadas anormalidades em 46,6% (348) dos indivíduos. Houve maior prevalência de eletrocardiogramas com anormalidades em pacientes com complicações clínicas perioperatórias (p=0,02). Não existiu diferença estatisticamente significativa nas dosagens de hemoglobina (14,0±1,6 g/dL em pacientes sem complicações intraoperatórias e 14,3±1,3 g/dL em pacientes com complicações -p=0,150) e nas de glicemia de jejum (104±29 mg/dL em pacientes sem complicações e 105±41 mg/dL em pacientes com complicações -p=0,850). Conclusões Dentro da rotina investigada de exames pré-operatórios para facectomia, apenas os resultados anormais presentes no eletrocardiograma estiveram associados à ocorrência de complicações durante o período de perioperatório. Abstract ObjectiveTo establish the prevalence of abnormal results in routine preoperative tests prior to

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A Novel Index of Elevated Risk of Inpatient Hospital Admission Immediately Following Outpatient Surgery

2007

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Hypothesis: Patients with increasing comorbidities are at increased risk of admission to an inpatient facility after outpatient surgery. Design and Setting: Data from operations performed in hospital-based and freestanding ambulatory surgery centers in New York during 1997 were obtained under the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project. Patients: Of the 783 558 patients eligible for inclusion in this study, 4351 were discharged directly for shortterm hospitalization (1:180), and 19 died (1:41 240). We performed a split-half analysis by randomly assigning the study sample to an analysis half for estimation or a holdout half for testing. Main Outcome Measures: We developed an outpatient surgery admission index from independent predictors of immediate hospital admission using the following point values: 65 years or older (1), operating time longer than 120 minutes (1), cardiac diagnoses (1), peripheral vascular disease (1), cerebrovascular disease (1), malignancy (1), seropositive findings for human immunodeficiency virus (1), and regional (1) or general anesthesia (2). Results: Increasing scores were associated with higher odds of admission relative to scores of 0 or 1. For scores of 4 or higher, the odds ratio was 31.96 (95% confidence interval, 26.29-38.86), and 2.8% of these patients were discharged to the hospital. For the holdout half of the data set, scores of 4 or higher had an odds ratio of 34.62 (95% confidence interval, 28.55-41.97). Conclusion: The proposed outpatient surgery admission index provides an evidence-based guide to assist clinicians and the health care systems in which they work in identifying patients at higher risk of immediate hospital admission.

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Are routine preoperative medical tests needed with cataract surgery?

Cited by 34 publications

References 20 publications

The impact of preoperative evaluation on perioperative events in patients undergoing cataract surgery: a cohort study

The impact of preoperative evaluation on perioperative events in patients undergoing cataract surgery: a cohort study

Valor preditivo de exames pré-operatórios em facectomias

A Novel Index of Elevated Risk of Inpatient Hospital Admission Immediately Following Outpatient Surgery

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