Routine preoperative medical testing for cataract surgery

Abstract

Background Cataract surgery is practiced widely and substantial resources are committed to an increasing cataract surgical rate in developing countries. With the current volume of cataract surgery and the increases in the future, it is critical to optimize the safety and cost-effectiveness of this procedure. Most cataracts are performed on older individuals with correspondingly high systemic and ocular comorbidities. It is likely that routine preoperative medical testing will detect medical conditions, but it is questionable whether these conditions should preclude individuals from cataract surgery or change their perioperative management. Objectives (1) To investigate the evidence for reductions in adverse events through preoperative medical testing, and (2) to estimate the average cost of performing routine medical testing. Search strategy We searched CENTRAL, MEDLINE, EMBASE and LILACS using no date or language restrictions. We used reference lists and the Science Citation Index to search for additional studies. Selection criteria We included randomized clinical trials in which routine preoperative medical testing was compared to no preoperative or selective preoperative testing prior to age-related cataract surgery. Data collection and analysis Two review authors independently assessed abstracts to identify possible trials for inclusion. For each included study, two review authors independently documented study characteristics, extracted data, and assessed methodological quality. Main results The three randomized clinical trials included in this review reported results for 21,531 total cataract surgeries with 707 total surgery-associated medical adverse events, including 61 hospitalizations and three deaths. Of the 707 medical adverse events reported, 353 occurred in the pretesting group and 354 occurred in the no testing group. Most events were cardiovascular and occurred during the intraoperative period. Routine preoperative medical testing did not reduce the risk of intraoperative (OR 1.02, 95% CI 0.85 to 1.22) or postoperative medical adverse events (OR 0.96, 95% CI 0.74 to 1.24) when compared to selective or no testing. Cost savings were evaluated in one study which estimated the costs to be 2.55 times higher in those with preoperative medical testing compared to those without preoperative medical testing. There was no difference in cancellation of surgery between those with preoperative medical testing and those with no or limited preoperative testing, reported by two studies. Authors’ conclusions This review has shown that routine pre-operative testing does not increase the safety of cataract surgery. Alternatives to routine preoperative medical testing have been proposed, including self-administered health questionnaires, which could substitute for health provider histories and physical examinations. Such avenues may lead to cost-effective means of identifying those at increased risk of medical adverse events due to cataract surgery. However, despite the rare occurrence, adverse medical ...

Preoperative Consultations for Medicare Patients Undergoing Cataract Surgery

“…These studies have not demonstrated improvements in specific perioperative or long-term outcomes, and the cost-effectiveness of such preoperative consultations has been questioned. 27,28 Previous research has established that routine preoperative medical testing is not indicated for patients undergoing cataract surgery, 5,29,30 and it has been argued that appropriate selective testing requires a preoperative physician assessment. 15 It remains unclear when such physician assessment can be adequately provided by the operating surgeon or anesthesia provider (both of whom receive global fees that include reimbursement for a preoperative assessment), as opposed to a separate preoperative medical consultant.…”

Safety and comparative costs of preoperative assessments for cataract surgery: traditional mandatory assessment versus a novel graded assessment system

“…Elimination of preoperative laboratory and diagnostic testing before cataract surgery has been shown to be safe. [4][5][6][7][8][9][10][11][12][13] Nevertheless, recent data suggest marked variability in testing requirements between centres, and many unnecessary tests are still being performed. 14,15 Additionally, many centres have entirely eliminated preoperative assessment before cataract surgery, either for select patients or for this patient population as a whole.…”

“…14,15 Additionally, many centres have entirely eliminated preoperative assessment before cataract surgery, either for select patients or for this patient population as a whole. Furthermore, centres still conducting preoperative assessments may feel pressure to eliminate them based on historically low complication rates 4,5,10,[16][17][18] and the large volume of pending cases. Even so, the evidence supporting elimination of assessment is anecdotal, and primary care H&Ps remain the standard of care in most areas.…”

Routine preoperative medical testing for cataract surgery

“…The initial electronic search of the literature conducted in December 2008 identified 1232 unique references (Keay 2009), of which 21 were assessed as relevant or possibly relevant. Full-text assessment of the 21 references resulted in the exclusion of 12 references from 11 studies, and the inclusion of nine references from three studies.…”