Abstract
Purpose :
Cataract surgery has long been one of the most commonly performed surgical procedures in the United States, but routine preoperative testing and evaluation have not been shown to decrease intra and postoperative risk. In the current pilot study, we report the outcomes of low-risk cataract surgery patients in a county-based health care system for whom pre-operative anesthesia evaluation was expedited and pre-operative testing was eliminated.
Methods :
A retrospective chart review of patients recruited at Harbor-UCLA Medical Center from January to July 2018 was performed. Surgical candidates underwent an initial screening questionnaire to identify low-risk patients appropriate for the expedited pathway (Figure 1), and subsequent telephonic preanesthesia evaluation within thirty days prior to surgery. Ocular and medical outcomes of cases, both intra and post-operative within a thirty-day period, were recorded to evaluate the safety of the expedited pathway.
Results :
Fifty-seven cases underwent the expedited preoperative pathway. Average operating time was 26.4 minutes with a turnover time of 32.5 minutes in between cases, compared to 32.5 and 30.5 minutes in cases with standard preoperative evaluation. There were no postponements or cancellations of surgeries. There were two intra-operative medical complications (3.5%), recorded as hypertension requiring administration of labetalol, and zero intra-operative ocular complications (0%). There were zero post-operative medical complications (0%), and five post-operative ocular complications within one week (8.8%) and four within one month (7.0%). All post-operative ocular complications were readings of increased intra-ocular pressure recorded at routine post-op visits. Figure 2 is a summary of outcomes of patients undergoing the expedited pathway.
Conclusions :
A novel protocol developed in a county-based hospital system to expedite preoperative evaluation and eliminate pre-operative testing prior to cataract surgery has been recently implemented. Initial results demonstrate no notable increase in procedural time and no major intra or postoperative complications, although further study will be required to establish statistical significance. These findings support a more robust initiative to forego routine medical testing prior to cataract surgery in a medically underserved county patient population without jeopardizing patient safety.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.