Patients May Still Be Getting Unnecessary Pre-Cataract Surgery Testing

Catherine L. Chen M.D., M.P.H. UCSF Dept of Interview with:
Catherine L. Chen M.D., M.P.H
UCSF Dept of Anesthesia

Medical Research: What is the background for this study? What are the main findings?

Dr. Chen: Cataract surgery is a very common and safe surgery that most older adults have in their 70’s or 80’s. It usually happens as a same-day surgery and most patients only need eye drops to numb the eye with little or no intravenous sedation for a procedure that on average is only 18 minutes long. Given their age, these patients typically have other concurrent medical problems, so even though multiple research studies and professional societies have concluded that routine preoperative testing is not necessary before cataract surgery, we found that this testing still frequently occurs in these patients. More than half of the patients in our study had at least one preoperative test performed in the month before their surgery.

We hypothesized prior to undertaking this study that the older and sicker patients were the ones who were most likely to get preoperative testing. Instead, what we found was that the most important factor that determined whether or not a patient got tested was the ophthalmologist who operated on the patient. This is an important finding because it shows that most patients are not getting extra testing, but the few that do are getting testing because that’s the way their ophthalmologist typically prepares his patients for surgery. Most of the time, this testing is not needed and will not affect how well the patient does during and after surgery.

Medical Research: What should clinicians and patients take away from your report?

Dr. Chen: Clinicians should consider not ordering any additional tests when their patients are scheduled for cataract surgery as long as the patient is in their normal state of health. Obviously, if the patient has any new symptoms during their preoperative office visit, physicians should order the appropriate tests to evaluate and manage that condition. Patients scheduled for cataract surgery should also ask their doctors whether they really need to have the testing performed for medical reasons other than the fact that they are having surgery.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Chen: Although we already know that routine preoperative tests do not change outcomes from cataract surgery, we do not have definitive data for preoperative office visits to a physician other than the ophthalmologist performing the surgery. It would be interesting to see whether these additional preoperative office visits are still necessary before cataract surgery. If the office visits also do not affect how well a patient does during and after the actual surgery, then this is an additional area where we can safely cut costs without compromising on healthcare quality.


Preoperative Medical Testing in Medicare Patients Undergoing Cataract Surgery

Catherine L. Chen, M.D., M.P.H., Grace A. Lin, M.D., M.A.S., Naomi S. Bardach, M.D., M.A.S., Theodore H. Clay, M.S., W. John Boscardin, Ph.D., Adrian W. Gelb, M.B., Ch.B., Mervyn Maze, M.B., Ch.B., Michael A. Gropper, M.D., Ph.D., and R. Adams Dudley, M.D., M.B.A.

N Engl J Med 2015; 372:1530-1538
April 16, 2015
DOI: 10.1056/NEJMsa141084

[wysija_form id=”1″] Interview with: Catherine L. Chen M.D., M.P.H. (2015). Patients May Still Be Getting Unnecessary Pre-Cataract Surgery Testing