Preoperative Consultation Before Cataract Surgery

Fleisher, Lee A.

doi:10.1001/jamainternmed.2013.12298

Cited by 11 publications

(6 citation statements)

References 7 publications

(4 reference statements)

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“…In particular, with the exception of ECG testing, the rates of pre-operative testing with plain radiography, hemoglobin, urinalysis, and cardiac stress testing were not significantly affected by the release of ACC/AHA and ASA guidance in the years following 2002. Our findings are consistent with the conclusions of previous studies that report overuse of testing in the pre-operative setting, including studies of pre-operative cardiac stress test use among patients with Medicare, 2 medical consultations for cataract surgery, 3 and testing prior to hernia repair, 1 among other studies. 9,20 Though we found little evidence of guideline impact, it is noteworthy that rates of pre-operative testing have generally fallen over time.…”

Section: Discussionsupporting

confidence: 92%

Use of Preoperative Testing and Physicians’ Response to Professional Society Guidance

et al. 2015

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The value of routine preoperative testing before most surgical procedures is widely considered to be low. To improve the quality of preoperative care and reduce waste, 2 professional societies released guidance on use of routine preoperative testing in 2002, but researchers and policymakers remain concerned about the health and cost burden of low-value care in the preoperative setting.OBJECTIVE To examine the long-term national effect of the 2002 professional guidance from the American College of Cardiology/American Heart Association and the American Society of Anesthesiologists on physicians' use of routine preoperative testing. DESIGN, SETTING, AND PARTICIPANTSRetrospective analysis of nationally representative data from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey to examine adults in the United States who were evaluated during preoperative visits from January 1, 1997, through December 31, 2010. A quasiexperimental, difference-in-difference (DID) approach evaluated whether the publication of professional guidance in 2002 was associated with changes in preoperative testing patterns, adjusting for temporal trends in routine testing, as captured by testing patterns in general medical examinations. MAIN OUTCOMES AND MEASURESPhysician orders for outpatient plain radiography, hematocrit, urinalysis, electrocardiogram, and cardiac stress testing. RESULTSDuring the 14-year period, the average annual number of preoperative visits in the

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Section: Discussionsupporting

confidence: 92%

Use of Preoperative Testing and Physicians’ Response to Professional Society Guidance

et al. 2015

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“…Additional research could better clarify the value of a medical history and physical examination performed by a provider other than the ophthalmologist before cataract surgery. 17,31 If these office visits and the resulting testing do not change outcomes, then efforts to reduce testing could also address ways to reduce office visits.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Medical Testing in Medicare Patients Undergoing Cataract Surgery

et al. 2015

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BACKGROUND Routine preoperative testing is not recommended for patients undergoing cataract surgery, because testing neither decreases adverse events nor improves outcomes. We sought to assess adherence to this guideline, estimate expenditures from potentially unnecessary testing, and identify patient and health care system characteristics associated with potentially unnecessary testing. METHODS Using an observational cohort of Medicare beneficiaries undergoing cataract surgery in 2011, we determined the prevalence and cost of preoperative testing in the month before surgery. We compared the prevalence of preoperative testing and office visits with the mean percentage of beneficiaries who underwent tests and had office visits during the preceding 11 months. Using multivariate hierarchical analyses, we examined the relationship between preoperative testing and characteristics of patients, health system characteristics, surgical setting, care team, and occurrence of a preoperative office visit. RESULTS Of 440,857 patients, 53% had at least one preoperative test in the month before surgery. Expenditures on testing during that month were $4.8 million higher and expenditures on office visits $12.4 million higher (42% and 78% higher, respectively) than the mean monthly expenditures during the preceding 11 months. Testing varied widely among ophthalmologists; 36% of ophthalmologists ordered preoperative tests for more than 75% of their patients. A patient’s probability of undergoing testing was associated mainly with the ophthalmologist who managed the preoperative evaluation. CONCLUSIONS Preoperative testing before cataract surgery occurred frequently and was more strongly associated with provider practice patterns than with patient characteristics. (Funded by the Foundation for Anesthesia Education and Research and the Grove Foundation.)

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“…10 Despite existing guidelines, knowledge related to LVC in the preoperative period, and the Choosing Wisely Campaign, that promotes discussions about professionalism in medicine and encourages conversations between doctors and patients in the last 10 years, these strategies seem insufficient to influence individual physician behaviour and even systemic efforts to address LVC in preoperative field. 10,11,18,31,35 Transformation on health system and individual provider levels is necessary for moving towards high-value. 10,38 Effective steps to reduce LVC include scientific evidence, new technologies applied to avoid repetitive care, understanding costs, and measuring outcomes.…”

Section: Discussionmentioning

confidence: 99%

Definition of low‐value care in a low‐risk preoperative population: A scoping review

John

Etges

Marcolino

et al. 2023

Evaluation Clinical Practice

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Rationale Preoperative care is one of the main areas in which to address low‐value care. A detailed definition of what low‐value care is in this period of the surgical care journey paves the way for new scientific research, clinical improvements, and reduction of unnecessary costs in this field. Aims and Objective To identify how low‐value care in low‐risk preoperative population has been defined in the scientific literature and propose a low‐value care framework with potential consequences in this setting. Methods Scoping review of theoretical studies and peer‐reviewed papers, including reviews, commentaries, or expert opinions, were considered eligible for inclusion. The following databases were consulted: MEDLINE (via PubMed), EMBASE, and SCOPUS (from inception to July 24, 2021), using a structured search with the keywords “low value care”, “clinical waste”, “preoperative”, and “elective procedures.” Two independent reviewers performed study selection and data extraction. The definition of low‐value care in the preoperative period and their consequences were described after extracting previous low‐value care concepts and summarising the contents. Also, a visual framework was built with this information. Results From 1519 publications identified in the initial searches, 22 underwent full‐text assessment, and 11 conceptual studies were included in the review. A total of four studies (36%) presented a general low‐value care definition, and all studies report some situations considered low‐value care in the preoperative field of low‐risk surgeries. The most common example of preoperative low‐value care, listed in nine studies (81%), was having asymptomatic patients undergo screening tests before surgery. The main clinical and nonclinical consequences of low‐value care in the preoperative phase included false‐positive results from exams as well as psychological distress, increased costs, and delay in surgery. Conclusions Revisiting and integrating previous definitions of low‐value care in low‐risk surgery into a scoping review is a starting point for de‐implementing unnecessary care and promoting improvements in surgical pathways.

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Preoperative Consultation Before Cataract Surgery

Cited by 11 publications

References 7 publications

Use of Preoperative Testing and Physicians’ Response to Professional Society Guidance

Use of Preoperative Testing and Physicians’ Response to Professional Society Guidance

Preoperative Medical Testing in Medicare Patients Undergoing Cataract Surgery

Definition of low‐value care in a low‐risk preoperative population: A scoping review

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