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Ajay Shalwala, Stephen J. Kim; The Value of Routine Preoperative Medical Testing for Vitreoretinal Surgery. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3750.
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Screening medical tests are routinely performed on patients in preparation for vitreoretinal surgery, but the benefit of this testing remains uncertain. This study aims to determine whether routine medical testing impacts the incidence of systemic adverse events in the intra-operative and post-operative periods.
Medical charts of 100 patients who underwent vitreoretinal surgery between January 2002 and November 2011 at the Vanderbilt University Medical Center were reviewed for pre-operative testing and medical adverse events occurring at the time of surgery and in the 30 days following surgery. Recorded pre-operative tests included serum electrolyte measurement, serum urea nitrogen measurement, serum creatinine measurement, complete blood count (CBC), and electrocardiography (EKG). Adverse events were recorded, which included myocardial infarction, bradycardia, heart failure, arrhythmia, acute hypertension, hypotension, stroke, transient ischemic attack, respiratory failure, bronchospasm, oxygen desaturation, hypoglycemia, diabetic ketoacidosis, and nonketotic hyperosmolar syndrome.
Of the 100 patients whose charts were reviewed, 80% underwent electrolyte and glucose testing and 79% underwent serum urea nitrogen and creatinine testing. The most frequent test performed was EKG, which was obtained in 84% of patients, and the least frequent test performed was CBC, which was obtained in only 26% of patients. There were a total of 6 adverse events: 2 acute hypertensive episodes, 2 episodes of desaturation requiring supplemental oxygen, 1 acute heart failure episode, and 1 hypotensive episode. No significant correlation between pre-operative tests performed and post-operative adverse events was found.
The incidence of adverse events following vitreoretinal surgery in this small series was 6%. Most patients undergoing pre-operative medical testing had a basic metabolic panel drawn, including electrolytes, glucose, and renal function tests. The majority of patients underwent EKG testing, but considerably fewer patients had CBCs drawn. There were no observed correlations between pre-operative testing and post-operative adverse events, but further investigation of the 2400 additional patients who underwent vitreoretinal surgery over the same time period may be informative.
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