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Jennifer Michelson, Philip Kurochkin, Jimmy K Lee; Routine Pre-op Medical Testing for Cataract Surgery: Is it necessary?. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1983.
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© ARVO (1962-2015); The Authors (2016-present)
Every year there are over 1.5 million cataract surgeries performed within the United States with estimated annual cost of $150 million Medicare dollars spent on routine medical testing prior to cataract surgery. The clinical practice guidelines set forth by the Department of Health and Human Services Agency did not specify what specific testing, if any, needs to be performed prior to cataract surgery. In 2015 the NEJM reported the preoperative cataract testing is more strongly associated with provider practice patterns than with patient characteristics. The purpose of the study is to help examine whether routine pre-operative medical testing before cataract extraction surgery was associated with decreased re-admission rates and hospitalization in the immediate post operative period.
A retrospective chart review of approximately 2,000 cataract cases from a single high volume surgeon between March 2013 to March 2015 were reviewed. Every patient that underwent cataract extraction during that time period was included in the study. We performed a retrospective review of the electronic medical records to determine which patients were admitted to any Montefiore Medical Center within 7 days after surgery. We sought to determine if routine pre-operative medical clearance was predictive in reducing admission to the hospital within 7 days.
Very few patients (5) were readmitted to the hospital within one week of surgery. Three of these five patients had pre-operative testing while two did not. Both patients with pre-operative testing as well as no preoperative testing underwent similar admission rates with no clinical significance between the two groups.
This study demonstrates that preoperative medical testing is not a predictor of adverse medical events following cataract surgery. Furthermore, routine pre-operative testing did not affect rate of hospitalizations within one week of cataract surgery suggesting that routine lab work prior to cataract surgery does not decrease post operative morbidity and mortality and could potential be a waste of medicare dollars.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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