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

Abstract

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.

Ambulatory cataract surgery centre without perioperative anaesthesia care: a prospective cohort study

“…Although some patients may be at high risk of complications (e.g. severe diabetes, severe renal dysfunction, severe liver dysfunction), there is good evidence that systematic preoperative blood test prior to cataract surgery does not increase the safety of cataract surgery while increasing costs 27 , 28 . Regarding the haemorrhagic complications related to antiplatelet and anticoagulant medications, some studies found a significantly higher incidence of subconjunctival haemorrhage but no significant difference in the incidence of complications nor visual outcomes 29 , 30 .…”

Anesthesia preoperative evaluation clinic (APEC) restructuring plan for improving the quality of surgical patient flow

“…Similarly, there was a significant reduction in APEC appointments for ophthalmic patients. A recent study of patients undergoing cataract surgery found no differences in major perioperative complications between those who underwent preoperative evaluation and those who did not, suggesting that this assessment has no effect on reducing adverse events in this population 22 . The adoption of an appointment screening system via consultant anesthesiologist was a key measure for improving surgical patient flow.…”

Cataract surgery practice patterns worldwide: a survey

“…Preoperative ocular diagnostics varied considerably (figure 4): 87% performed optic biometry, 28% ultrasonic biometry, 55% endothelial microscopy, 47% Optical Coherence Tomography (OCT), 30% corneal topography. Interestingly, 26/209 (12.4%) performed ultrasonic biometry as the only pre-op diagnostics; 2.9% of responders performed all six tests, 7.8% performed five tests, 13 Open access not surgical volume significantly influenced this choice: 38% of private practices performed four or more tests versus 20% academic centres and 11% of public hospitals (table 1).…”

“…Routine preoperative medical tests requested by 50% of survey responders have been often alleged unnecessary [11][12][13] and replaced with preoperative assessment by a physician with or without the help of self-administered questionnaires 14 as was the case in our survey. It should be noted that both raise direct and indirect costs: a basic panel of blood exams has an average cost of US$25 and ECG US$30 (US$55 per surgery) plus at least 30 min of personnel time adding another US$55 per procedure, 15 while physical assessment and interview would require at least 20 min of a physician (US$110/3=US$36.6 per surgery).…”