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Ajay Shalwala, Richard Hwang, Ariana Tabing, Stephen Kim; The Value of Routine Preoperative Medical Testing Before Vitreoretinal Surgery. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2148.
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Screening medical tests are performed on patients in preparation for vitreoretinal surgery, but the benefit of routine testing is uncertain. This study aims to determine the predictive value of routine medical testing for post-operative systemic adverse events.
Medical charts of 2103 patients aged 17 or greater who underwent vitreoretinal surgery between January 2002 and November 2011 at Vanderbilt University in Nashville, Tennessee were reviewed for baseline comorbidities, pre-operative testing, and adverse events occurring at the time of or within 30 days of surgery. Charts were excluded if there were less than 7 days of documented follow-up. Logistic regression analysis was performed to correlate adverse events with pre-operative testing and baseline comorbidities.
Of 2033 included patients, 83 experienced adverse events, with 9 patients having multiple events. Of 95 total adverse events observed, 66 (69%) occurred in the first 24 hours post-operatively, while the remaining 29 (31%) occurred between post-operative days 1 and 30. The most common adverse events were bradycardia (22 events) and desaturation (19 events). Presence of coronary artery disease, chronic renal failure, chronic liver disease, and history of cerebrovascular accident all independently predicted adverse events (p < 0.05), while age, race, diabetes, COPD, smoking history, asthma, and systemic malignancy were not associated. Pre-operative renal function testing (blood urea nitrogen and creatinine) appeared to reduce the risk of adverse events (p < 0.05) while general anesthesia increased the risk compared to local anesthesia (p < 0.001).
The incidence of adverse events following vitreoretinal surgery in this series was 4.1%. General anesthesia and the presence of specific comorbidities increased the risk of adverse events while pre-operative renal function testing appeared to be protective. This information may allow more selective testing for those individuals at greatest risk for adverse systemic events after vitreoretinal surgery and consequently reduce the burden of routine testing in those individuals at low risk.
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