Do Ophthalmologists, Anesthesiologists, and Internists Agree About Preoperative Testing in Healthy Patients Undergoing Cataract Surgery?

Bass, Eric B.; Steinberg, Earl P.; Luthra, Rajiv; Schein, Oliver D.; Tielsch, James M.; Javitt, Jonathan C.; Sharkey, Phoebe D.; Petty, Brent G.; Feldman, M; Steinwachs, Donald M.

doi:10.1001/archopht.1995.01100100036025

Cited by 62 publications

(36 citation statements)

References 17 publications

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“…Bass et al, 16 found that up to 80% of surgeons, anesthesiologists and consulting internists ordered laboratory testing that they themselves felt to be unnecessary in the belief that institutional rules, "medical-legal considerations" or one of the other specialties involved in the case would require them. Fischer, examining the costs and benefits of a preoperative anesthesia evaluation unit, 17 showed that the number of laboratory tests and medical consults both decreased by greater than 50% when responsibility for surgical preparation of patients was given to the anesthesiology service alone.…”

Section: Discussionmentioning

confidence: 99%

Preoperative medical consultations: impact on perioperative management and surgical outcome

Katz

Cimino

Vitkun

2005

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : This study was designed to assess the effect of preoperative medical consults on both perioperative management and surgical outcome.M Me et th ho od ds s: : The charts of 387 consecutive patients over the age of 50 undergoing non-cardiac, elective surgery during a six-week period were retrospectively examined. Patient factors including age, ASA status, gender, type of surgery, outcome (death, unexpected intensive care unit admission or uncomplicated discharge), presence of medical consult, and, in those cases where a medical consult was present, stated reason for the consult, the ordering physician, and recommendations of the consultant, were recorded. R Re es su ul lt ts s: : 138 patients receiving medical consults (35.7%) were identified (a total of 146 consults). The most common stated purpose of the consults examined was "preoperative evaluation." In only five consults (3.4%) did the consultant identify a new finding. Sixty-two consults (42.5%) contained no recommendations. There was no statistically significant difference in outcome between those patients who received a medical consult and those who did not.C Co on nc cl lu us si io on n: : A review of 146 medical consults suggests that the majority of such consults give little advice that truly impacts either perioperative management or outcome of surgery. NESTHESIOLOGISTS and surgeons frequently request preoperative consultation from internists and family practitioners for patients with pre-existing or suspected disease. There can be considerable confusion, however, amongst physicians regarding both the reasons for which a consult was requested 1 and the ultimate purposes that the consult serves. Objectif : Évaluer l'effet des consultations médicales préopératoires2 Such confusion often results in consultants' recommendations being ignored.3 Kleinmann found that very few anesthesiologists or surgeons specify what is being requested when asking for a cardiology consult.4 Lee 1 documented that in 14% of cases, requesting physicians and medical consultants actually disagreed on the reasons for the consult. Rudd, 5 in a study on preoperative

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Section: Discussionmentioning

confidence: 99%

Preoperative medical consultations: impact on perioperative management and surgical outcome

Katz

Cimino

Vitkun

2005

Can J Anesth/J Can Anesth

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“…As with ophthalmic tests, private practice, cataract speciality and inpatient surgery were associated with a greater use of urinalysis and other tests. US [22] and Barcelona ophthalmologists were similar in their reported use of preoperative medical tests. The high use of medical testing in Barcelona may be related with a historical trend of performing cataract surgery under general anesthesia and/or as an inpatient procedure (an average of 68% of the extractions are performed as an inpatient procedure).…”

Section: Discussionmentioning

confidence: 82%

Preoperative testing practice in healthy cataract surgery patients. Results of a survey of ophthalmologists in Barcelona, Spain

1997

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Aims~Background: Many preoperative ophthalmic and medical tests lack proven effectiveness in the evaluation of cataract surgery patients. Variation in use has been described in the USA, but little information is available for countries with different health systems. The objectives of the study were to assess variation in ophthalmologists' use of preoperative testing on cataract surgery patients and to identify ophthalmologists' characteristics associated with it. Methods: A postal survey was made in a representative sample (response rate of 70%) of the Barcelona Medical Association of Ophthalmologists performing cataract surgery during 1993 (N --89). The questionnaire included information about common preoperative, intraoperative and postoperative practice and sociodemographic and professional data. Appropriateness of preoperative ophthalmic tests was classified in 3 levels (indicated tests, tests with unproven benefit, and non-indicated tests) according to recommendations of the Cataract Management Guideline Panel [ 1] and the American Academy of Ophthalmology Preferred Practice Pattern [2]. Results: Almost all the ophthalmologists reported performing Fundus exam plus A-scan in the preoperative evaluation of cataract surgery patients (indicated tests). Up to 20% reported performing 'frequently' or 'always' some non-indicated or unproven benefit ophthalmic tests. Additionally, an average of 7 medical tests were 'routinely' included. Private practice and cataract subspeciality were the ophthalmologists' characteristics more frequently associated with the use of inappropriate ophthalmic tests (p < 0.05). Conclusions: In Barcelona, Spain, some ophthalmic tests of unproven effectiveness are frequently performed preoperatively on cataract surgery patients without ocular comorbidity. Also, a generalized utilization of several medical tests was reported. There is potential for some cost containment and more appropriate care of cataract patients without diminishing the quality of care, in a location with low surgery rates.

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“…Alguns autores mostraram variação substancial nos testes solicitados por oftalmologistas, anestesiologistas e clínicos. 5,6 O ato de requisitar testes não indicados pelo exame clínico pode ser prejudicial para o paciente. 12 Um exemplo disto é quando resultados falso-positivos desviam a atenção do problema principal ou levam a um adiamento desnecessário da cirurgia.…”

Section: Discussionunclassified

“…Outra limitação é que se avaliou uma rotina relativamente sucinta de exames (eletrocardiograma, hemoglobina e glicemia), mas estes são os exames mais requisitados em facectomias, além de ser a rotina utilizada previamente no hospital estudado. 4,5 Também não foram observadas intercorrências clínicas que pudessem ser contornadas com intervenção médica das que levaram à interrupção do procedimento (responsável pela suspensão de apenas 4,5% das facectomias no hospital estudado). 11 Se tivessem sido considerados os cancelamentos, isoladamente, como parâmetros de comparação dos grupos, seria necessária uma amostra maior (com pelo menos o dobro de pacientes).…”

Section: Discussionunclassified

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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Do Ophthalmologists, Anesthesiologists, and Internists Agree About Preoperative Testing in Healthy Patients Undergoing Cataract Surgery?

Cited by 62 publications

References 17 publications

Preoperative medical consultations: impact on perioperative management and surgical outcome

Preoperative medical consultations: impact on perioperative management and surgical outcome

Preoperative testing practice in healthy cataract surgery patients. Results of a survey of ophthalmologists in Barcelona, Spain

Valor preditivo de exames pré-operatórios em facectomias

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