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Alexa Dessy, Eileen Mayro, Robert Bailey, Douglas Wisner, Anish Koka, Lisa A Hark, Ben Leiby, Nooreen Dabbish, Ann P Murchison, Adedoyn Okulate, Caitlin Green, Laura Pizzi, Julia A Haller; A proposed intervention to decrease resident-performed cataract surgery cancellation. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5054.
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The value of preoperative testing in reducing cancellations among cataract surgeries remains in question. We performed a cluster-randomized, controlled trial to investigate the effects of several non-medical procedures on surgery cancellations, including mandatory preadmission testing (PAT) with an affiliated cardiologist on the same day surgery was scheduled.
441 subjects scheduled for cataract surgery were enrolled and randomized, with 201 subjects (45.6%) in the intervention group and 240 subjects (54.4%) in the usual care group. The mean age was 65.5 years (SD + 12.3) and 248 (56.2%) were female. Patients younger than 18, residing in a nursing home, on dialysis or incarcerated were excluded. The intervention group completed same-day, on-site PAT with an affiliated cardiologist, while the usual care group was instructed to complete PAT at their primary care physician (PCP). Subjects who cancelled surgery without rescheduling were deemed cancellations. Logistic regression was used to analyze the effect of intervention on cancellation and to evaluate the baseline factors associated with cancellation. The Wills Eye Hospital (WEH) Institutional Review Board approved the study.
The overall cancellation rate was 14.5%, nearly 50% of the cancellation rate in our previous study (29.5%). In total, 413 subjects (93.7%) completed PAT and 377 subjects (85.5%) attended cataract surgery. Female subjects (p=0.015, OR (95% CI): 1.74 (1.11-2.71) and subjects who lived further away from WEH (p<0.0001, OR (95% CI): 1.05 (1.03-1.08) were more likely to cancel cataract surgery, respectively. Cancellation rates by location were as follows: incomplete PAT 100%, PAT on-site 5.5%, and PAT with PCP 10.9%. The association between PAT location and cancellation status did not reach significance (p=0.055). Reasons for cancellation were grouped into sickness, transportation, not having clearance, unable to recall, family situations, insurance, other, and unknown. There was no association between randomization group and reason for cancellation (p=0.094).
The lowest cancellation rates were observed among subjects who completed PAT on-site. Although this finding was not statistically significant, the intervention provided a patient-centered approach to address a major reason for surgery cancellation at our institution, and has since been incorporated to the standard protocol for WEH.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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