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

Abstract

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.