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Impact of Preoperative Testing on Patients Undergoing Ophthalmologic Surgery: A Retrospective Cohort Study

      Abstract

      Objective

      : Routine medical testing is not recommended before cataract surgery, but no consensus exists about preoperative testing before general ophthalmologic surgery. We aimed to assess the impact of preoperative testing on patients undergoing ophthalmologic surgery by analyzing their surgical outcomes and complications.

      Methods

      : We retrospectively reviewed electronic health records of patients who had preoperative evaluations before cataract or noncataract ophthalmologic surgery at a tertiary care center from January 1, 2015, through December 31, 2019.

      Results

      : The cohort consisted of 2268 patients (1270 [56.0%] women). The most frequent ophthalmologic procedure was cataract extraction (n = 1450 [63.9%]). Laboratory tests results were available for 489 patients (33.7%) in the cataract group; of these, 275 results (56.2%) had abnormal values, and 18 patients (6.5%) required preoperative interventions. Preoperative test results were available for 772 out of 818 patients (94.4%) having noncataract procedures. Of these, 384 results (49.7%) had abnormal values, and 10 patients (2.6%) required additional intervention. No significant differences were observed for the rate of surgery cancellations between the cataract and noncataract patient groups (0.6% vs 1.0%; P = .24). Of the 12 patients (0.5%) who had complications, all had undergone preoperative testing.

      Conclusions

      : No differences in outcomes and complications were observed among patients who underwent cataract or noncataract surgery. It is reasonable to consider avoiding preoperative testing in patients undergoing ophthalmologic surgery.

      Keywords

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      References

        • Resnikoff S
        • Pascolini D
        • Etya'ale D
        • et al.
        Global data on visual impairment in the year 2002.
        Bull World Health Organ. 2004; 82: 844-851
        • Klein BEK
        • Howard KP
        • Lee KE
        • Klein R.
        Changing incidence of lens extraction over 20 years: the Beaver Dam eye study.
        Ophthalmology. 2014; 121: 5-9
        • Fleisher LA
        • Beckman JA
        • Brown KA
        • et al.
        ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery): developed in collaboration with the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery.
        Circulation. 2007; 116: e418-e499
        • Chen CL
        • Lin GA
        • Bardach NS
        • et al.
        Preoperative medical testing in Medicare patients undergoing cataract surgery.
        N Engl J Med. 2015; 372: 1530-1538
        • Zaidi FH
        • Corbett MC
        • Burton BJ
        • Bloom PA.
        Raising the benchmark for the 21st century–the 1000 cataract operations audit and survey: outcomes, consultant-supervised training and sourcing NHS choice.
        Br J Ophthalmol. 2007; 91: 731-736
        • Kirkham KR
        • Wijeysundera DN
        • Pendrith C
        • et al.
        Preoperative testing before low-risk surgical procedures.
        CMAJ. 2015; 187: E349-E358
        • Rusk MH.
        Avoiding unnecessary preoperative testing.
        Med Clin North Am. 2016; 100: 1003-1008
        • Cavallini GM
        • Saccarola P
        • D'Amico R
        • Gasparin A
        • Campi L
        Impact of preoperative testing on ophthalmologic and systemic outcomes in cataract surgery.
        Eur J Ophthalmol. 2004; 14: 369-374
        • Schein OD
        • Katz J
        • Bass EB
        • et al.
        The value of routine preoperative medical testing before cataract surgery. Study of Medical Testing for Cataract Surgery.
        N Engl J Med. 2000; 342: 168-175
        • Arieta CE
        • Nascimento MA
        • Lira RP
        • Kara-Jose N.
        [Waste of medical tests in preoperative evaluation for cataract surgery].
        Cad Saude Publica. 2004; 20: 303-310
        • Tallo FS
        • Soriano ES
        • Alvarenga LS.
        [Preoperative evaluation and cataract surgery].
        Arq Bras Oftalmol. 2007; 70: 633-637
        • Imasogie N
        • Wong DT
        • Luk K
        • Chung F.
        Elimination of routine testing in patients undergoing cataract surgery allows substantial savings in laboratory costs. A brief report.
        Can J Anaesth. 2003; 50: 246-248
        • Mafi JN
        • Godoy-Travieso P
        • Wei E
        • et al.
        Evaluation of an intervention to reduce low-value preoperative care for patients undergoing cataract surgery at a safety-net health system.
        JAMA Intern Med. 2019; 179: 648-657
        • Perez-Campagne E
        • Basdekidou C
        • Petropoulos IK
        • Noachovitch B
        • Moubri M.
        Impact of preoperative and intraoperative factors in cataract surgery.
        Klin Monbl Augenheilkd. 2013; 230: 326-328
        • Keay L
        • Lindsley K
        • Tielsch J
        • Katz J
        • Schein O.
        Routine preoperative medical testing for cataract surgery.
        Cochrane Database Syst Rev. 2009; 1CD007293
        • Shalwala A
        • Hwang RY
        • Tabing A
        • Sternberg Jr., P
        • Kim SJ
        The value of preoperative medical testing for vitreoretinal surgery.
        Retina. 2015; 35: 319-325
        • von Elm E
        • Altman DG
        • Egger M
        • et al.
        The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.
        J Clin Epidemiol. 2008; 61: 344-349
        • Roizen MF.
        More preoperative assessment by physicians and less by laboratory tests.
        N Engl J Med. 2000; 342: 204-205
        • Power M
        • Fell G
        • Wright M.
        Principles for high-quality, high-value testing.
        Evid Based Med. 2013; 18: 5-10