Safety and comparative costs of preoperative assessments for cataract surgery: traditional mandatory assessment versus a novel graded assessment system

Jastrzebski, André; Villafranca, Alexander; Sethi, Subash; Bellan, Lorne

doi:10.1007/s12630-016-0626-x

Cited by 20 publications

(3 citation statements)

References 22 publications

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“…Specifically, we identified no increase in the rates of intraoperative complications, noneyerelated ED visits, or inpatient readmissions after the intervention. These results are in line with several previous cataract surgery studies: Benoit et al 7 found no increase in adverse medical events with the omission of a preoperative history and physical examination for low-risk patients screened with a preoperative questionnaire; Alboim et al 8 and Jastrzebski et al 9 found no increase in adverse perioperative or postoperative outcomes and concluded that a comprehensive preoperative evaluation was minimally beneficial and not cost effective. The findings of our study strengthen the evidence for a tailored approach to cataract surgery preoperative evaluation to eliminate low-value interventions without compromising patient safety.…”

Section: Discussionsupporting

confidence: 90%

Feasibility of a Risk-Based Approach to Cataract Surgery Preoperative Medical Evaluation

et al. 2021

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IMPORTANCEIn 2019, the US Centers for Medicare & Medicaid Services implemented the Patients Over Paperwork initiative, allowing hospitals and ambulatory surgery centers to establish their own policies on preoperative history and physical requirements. A risk-based approach to preoperative medical evaluation may allow surgeons to provide high-value patient care.OBJECTIVE To assess the feasibility of a risk-based approach to cataract surgery preoperative medical evaluation through a lens of safety and throughput. DESIGN, SETTING, AND PARTICIPANTSA pilot study was performed to evaluate the implementation of a risk-based approach to preoperative medical evaluation for cataract surgery using a virtual medical history questionnaire. The intervention group, seen from June to September 2020, received the risk assessment and those who were low risk proceeded to surgery without further preoperative evaluation prior to the day of surgery. The preintervention control group included patients who received standard care from January to December 2019.MAIN OUTCOMES AND MEASURES Primary outcomes included rates of intraoperative complications, noneye-related emergency department visits within 7 days, inpatient admissions within 7 days of surgery, case delays, and rates of case cancellation. The secondary outcome included patient perception regarding preoperative care.RESULTS A total of 1095 patients undergoing cataract surgery were included in the intervention group (1813 [58.2%] female) and 3114 were in the control group (621/1095 [56.7%] female). The mean (SD) age was 68.6 (11.0) in the control group and 68.4 (10.5) in the intervention group. The intervention group included 126 low-risk individuals (11.5%) and 969 individuals who received standard care (88.5%). There were no differences between the control and intervention groups in terms of rates of intraoperative complications (control group vs intervention group: 21 [0.7%] vs 3 [0.3%]; difference, −0.4% [95% CI, −0.82 to 0.02]), 7-day noneye-related ED visits (5 [0.2%] vs 3 [0.3%]; difference, 0.1% [95% CI, −0.23 to 0.45]), 7-day inpatient admissions (6 [0.2%] vs 2 [0.2%]; difference, −0.01% [95% CI, −0.31 to 0.29]), or same-day cancellations (31 [0.8%] vs 10 [0.6%]; difference, −0.15% [95% CI, −0.63 to 0.34]). The control group had more case delays (59 [1.9%] vs 7 [0.6%]; difference, −1.3% [95% CI, −1.93 to −0.58]). CONCLUSIONS AND RELEVANCEThis study suggests that a virtual, risk-based approach to preoperative medical evaluations for cataract surgery is associated with safe and efficient outcomes. These findings may encourage health care systems and ambulatory surgery centers to tailor preoperative requirements for low-risk surgery patients.

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Section: Discussionsupporting

confidence: 90%

Feasibility of a Risk-Based Approach to Cataract Surgery Preoperative Medical Evaluation

et al. 2021

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“…3 Jastrzebski et al also advocates a graded approach to preoperative assessments. 4 Based on our results, we believe the universal application of independent and complete in-person H&Ps for patients undergoing cataract surgery is not medically necessary for most patients, represents low-value care, and increases visit burden. At BMC phone visits are now standard for all eye surgery, including non-cataract eye procedures, and is considering expansion of phone visits to other non-ocular procedures that are similarly short in duration requiring monitored IV sedation.…”

Section: Discussionmentioning

confidence: 68%

Phone Interviews for Preoperative Medical Evaluation for Cataract Surgery

et al. 2019

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“…CEA are evaluated for surgical techniques; however, costs of clinical systems of cataract grading and preoperative new measurements have also been investigated. The high costs of setting up the novel technology are offset by low running costs [71,72]. In fact, other preoperative screening CEA cost-effectiveness analysis, CUA cost-utility analysis, ISCS immediate sequential cataract surgery, DSCS delayed sequential cataract surgery, VA visual acuity, ICER incremental cost-effectiveness ratio, QALY quality-adjusted life year measurements have been evaluated, such as optical coherence tomography (OCT) during the evaluation of a patient considering cataract surgery, being cost-effective from a third-party payer and societal perspective, as it could increase the detection of macular pathologies and improved the QALYs over time [74].…”

Section: Discussionmentioning

confidence: 99%

Economic Evaluation of Cataract: A Systematic Mapping Review

et al. 2023

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Introduction:The purpose of this article was to ascertain the existing literature and find the gaps in economic evaluations of cataracts. Methods: Systematic methods were used to search and collect the published literature on economic evaluations of cataracts. A mapping review of studies published in the following bibliographical databases was performed: the National Library of Medicine (PubMed), EMBASE, Web of Science (WOS), and the Central of Reviews and Dissemination (CRD) database. A

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Safety and comparative costs of preoperative assessments for cataract surgery: traditional mandatory assessment versus a novel graded assessment system

Cited by 20 publications

References 22 publications

Feasibility of a Risk-Based Approach to Cataract Surgery Preoperative Medical Evaluation

Feasibility of a Risk-Based Approach to Cataract Surgery Preoperative Medical Evaluation

Phone Interviews for Preoperative Medical Evaluation for Cataract Surgery

Economic Evaluation of Cataract: A Systematic Mapping Review

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