Routine preoperative medical testing for cataract surgery

Keay, Lisa; Lindsley, Kristina; Tielsch, James M.; Katz, Joanne; Schein, Oliver D.

doi:10.1002/14651858.cd007293.pub3

Cited by 90 publications

(77 citation statements)

References 38 publications

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“…Studies have demonstrated that hypertension, bronchospasm, and arrhythmia account for 490% of intraoperative medical events in cataract surgery, and routine preoperative testing does not appear to predict their occurrence. 22 Recent data indicate a reduction in the number of preoperative investigations when patients are evaluated in preoperative clinics. 4 However, in the present study, most tests were ordered by the ophthalmologist before the patient was seen by a specialist for preoperative evaluation.…”

Section: Discussionmentioning

confidence: 99%

The impact of preoperative evaluation on perioperative events in patients undergoing cataract surgery: a cohort study

Alboim

Kliemann

Soares

et al. 2016

Eye

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Purpose Ambulatory surgery is a major area of surgical and anesthetic practice, and preoperative clinics are being increasingly used for low-risk surgical procedures. This study investigated the impact of preoperative evaluation on perioperative events in patients undergoing cataract surgery. Methods This was a retrospective cohort study of 968 consecutive patients undergoing cataract surgery. Details of medical conditions, surgical, anesthetic, and postoperative information were collected from medical records. A logistic regression model was developed using propensity score adjustment for baseline characteristics. Results Out 968 patients included, 240 (24.7%) underwent outpatient preoperative evaluation. There were no perioperative major cardiovascular events. Hypertension occurred in 319 (33%) patients, accounting for 79.7% of all adverse events. Preoperative evaluation resulted in a lower hypertension rate after adjustment for propensity score (OR = 0.6; 95% CI 0.41-0.93); no effects were observed on posterior capsule rupture and emergency visits/hospitalization within 7 days of surgery. Eighty-nine patients (9.3%) had an initial systolic pressure ≥ 180 mm Hg, which was not associated with higher risk of posterior capsule rupture (P = 0.158) or postoperative adverse events (P = 0.902). Median waiting time to surgery was 6 and 2 months for evaluated and non-evaluated patients, respectively (Po0.001). Conclusions In the context of low-risk surgery and no major perioperative and postoperative outcomes, it appears that outpatient preoperative evaluation has no role in reducing adverse events in cataract surgery candidates. Despite fewer hypertensive episodes observed in evaluated patients, these episodes were not associated with any medical or surgical outcomes.

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Section: Discussionmentioning

confidence: 99%

The impact of preoperative evaluation on perioperative events in patients undergoing cataract surgery: a cohort study

Alboim

Kliemann

Soares

et al. 2016

Eye

View full text Add to dashboard Cite

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“…A lot of them are outpatients, with the use of local anesthesia, usually in conjunction with intravenous sedation. The perioperative morbidity and mortality rates associated with cataract surgery are low 12,26 . However, patients tended to be older and have significant coexisting illnesses.…”

Section: Discussionmentioning

confidence: 99%

The pre-anesthetic evaluation for ophthalmic surgery in the elderly is really necessary? The reality of a public hospital

Bisinotto¹,

Mesquita²,

Miziara³

et al. 2016

Revista Brasileira De Oftalmologia

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“…12,52 A comprehensive assessment of preoperative health status, based on evidence-based recommendations and a detailed workup in selected patients using a risk stratification methodology, can be just as effective in reducing intraoperative or postoperative adverse medical events as a routine workup. 24 In the present study, all patients underwent preoperative stratification and clearance by their primary care physician and were preoperatively verified by the anesthesia team before admission to the OR. Such approaches have been shown to be cost effective.…”

Section: Targeting Cost Of Medical and Surgical Complicationsmentioning

confidence: 99%

“…Such approaches have been shown to be cost effective. 24 The only patient who presented with a medical complication (unstable angina) after surgery had been stratified at a low cardiac risk preoperatively. The implementation of the Surgical Care Improvement Project (SCIP) has also led to reductions in perioperative complications by tackling surgical site infection prevention, venous thromboembolism prevention, use of perioperative beta-blockers, serum glucose level monitoring, normothermia, and use of clippers for hair removal.…”

Section: Targeting Cost Of Medical and Surgical Complicationsmentioning

confidence: 99%

Value-based neurosurgery: measuring and reducing the cost of microvascular decompression surgery

McLaughlin¹,

Upadhyaya²,

Buxey³

et al. 2014

JNS

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H ealtH care expenditures in the US continue to rise annually, faster than the national income. In 2010, health spending exceeded 17% of the nation's gross domestic product. 23,29 Numerous elements of national health reform are aimed at cost containment. Importantly, "bending the cost curve" refers most commonly to the government or insurers' payment to providers. However, reducing reimbursements does not decrease the cost of care delivery. The critical issue is how to deliver improved outcomes at the lowest cost and achieve the highest value of care. 41 Although health care providers have put significant effort into the quality and safety of care delivered in the past decade, little attention has been focused on cost measurement and even less on cost containment. This oversight stems from the fact that health systems, departments, and individual physicians misunderstand the costs related to the care they deliver.Early in 2009, the Department of Neurosurgery at our institution, aiming to improve the delivery of neurosurgical care, launched a Clinical Quality Program.2 Numerous improvement processes aimed at optimizing preoperative, intraoperative, and postoperative patient care were implemented by the third quarter of 2009. Previously, we assessed whether the multidisciplinary and multifaceted efforts instituted in 2009 succeeded in improving our delivery of value-based neurosurgery. 2,32 For that initial case study, patients undergoing microvascular decompression (MVD) performed by one neurosurgeon (N.A.M.) was the proposed model given that the surgical technique was standard, anticipated operative risks were relatively predictable, and perioperative care was relatively similar between cases. We documented a favorable impact from Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CaliforniaObject. Care providers have put significant effort into optimizing patient safety and quality of care. Value, defined as meaningful outcomes achieved per dollar spent, is emerging as a promising framework to redesign health care. Scarce data exist regarding cost measurement and containment for episodes of neurosurgical care. The authors assessed how cost measurement and strategic containment could be used to optimize the value of delivered care after the implementation and maturation of quality improvement initiatives.Methods. A retrospective study of consecutive patients undergoing microvascular decompression was performed. Group 1 comprised patients treated prior to the implementation of quality improvement interventions, and Group 2 consisted of those treated after the implementation and maturation of quality improvement processes. A third group, Group 3, represented a contemporary group studied after the implementation of cost containment interventions targeting the three most expensive activities: pre-incision time in the operating room (OR) and total OR time, intraoperative neuromonitoring (IOM), and bed assignment (and overall length of stay [LOS]). The value of care was assessed for all...

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Routine preoperative medical testing for cataract surgery

Cited by 90 publications

References 38 publications

The impact of preoperative evaluation on perioperative events in patients undergoing cataract surgery: a cohort study

The impact of preoperative evaluation on perioperative events in patients undergoing cataract surgery: a cohort study

The pre-anesthetic evaluation for ophthalmic surgery in the elderly is really necessary? The reality of a public hospital

Value-based neurosurgery: measuring and reducing the cost of microvascular decompression surgery

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