|
Specialty Spotlight
Cataract
Surgery and Preoperative Testing
-
Schein OD, for the study of Medical Testing for Cataract Surgery [John Hopkins Univ., Baltimore, Md; et al
The Value of Routine Preoperative Medical Testing Before Cataract Surgery
N Engl J Med 342: 168-175, 2000
The rates of perioperative morbidity and mortality after cataract surgery are low, despite the fact that patients are elderly and have serious coexisting illnesses. These patients commonly undergo routine medical testing before cataract surgery. A prospective randomized clinical trial was performed to determine whether routine medical testing before cataract surgery reduces the rate of complications in the perioperative period.
A total of 19,248 elective cataract surgeries [ 18,819 patients], from 9 centres, were randomly assigned to be preceded or not preceded by a battery of medical tests [electrocardiography, complete blood count, serum electrolytes, urea nitrogen, creatinine, and glucose]., in addition to a history and physical examination.
Patients were followed up for adverse events during operation and during seven days after surgery. In the no-tests group, there were 9408 patients undergoing 9624 surgeries; and in the other group there were 9411 patients with 9624 surgeries. The over-all rate of perioprative complications was the same for both groups [ 31.3 events per 1000 surgeries]. The no-testing and the testing groups had similar rates of intraoperative events [19.2 vs 19.7] and postoperative events [12.6 vs 12.1] per 1000 surgeries.
It was concluded that routine medical testing before cataract surgery does not improve the safety of the surgical procedure. It is possible to save the high costs of routine medical testing without any negative effects on patients health or clinical outcome. It is also reasonable to apply these observations to other patients undergoing other surgeries with low surgical risks, under local anesthesia and IV sedation.
