THE VALUE OF ROUTINE PREOPERATIVE M...

THE VALUE OF ROUTINE PREOPERATIVE MEDICAL TESTING BEFORE CATARACT SURGERY contemplation OF MEDICAL TESTING FOR CATARACT SURGERY O D Schein et al The strange England Journal of Medicine Vol 342 (January 2000) 168-175

It is estimated that the richness of routine medical testing before cataract surgery overstep the proper limits $150 million annually. Cataract surgery also is believed to be the greatest in quantity frequently performed surgery in older adults and usually is performed onward an outpatient basis with IV sedation. The Agency for Health Care Policy and Research has published guidelines for the management of cataracts and endorsed appropriate testing, if it be not that it has not provided specific recommendations. The rates of perioperative mortality and morbidity associated with cataract surgery are low; however, many patients choosing to suffer the surgery have existing illnesses. Physicians order routine laboratory proofs to satisfy institutional requirements and medicolegal touchs or because they believe that another physician wants them performed. to be ascribed to the variation in the proofs ordered and the uncertainty regarding the effectiveness of testing, a prospective, randomized clinical trial was performed to determine whether routine medical testing before cataract surgery models the rate of complications during the perioperative period.

Methodology. Patients from nine clinical center voluntarily participated in the close attention The nine centers included a mixture of ambulatory center academic medical center and community hospitals. Patients were recruited from June 1995 to June 1997 and those who chose to participate were assigned randomly through computer to be in the no-test assemblage (ie, no routine medical testing before surgery) or the routine-testing arrange (ie, routine testing before surgery) Researchers evolveed exclusionary criteria. Data were mustered preoperatively from the patient and health care provider. The anesthesia care provider and nursing staff members scrape togethered data intraoperatively. The study coordinator infered postoperative data one week after surgery

When an adverse fact occurred, an internist and an anesthesia care provider reviewed the patient's medical records to determine whether it met single of the definitions of an adverse termination These reviewers were not aware of the reflection group assignments of the patients. This summary then was reviewed in a masked fashion according to one of two internists who made a clinical decision regarding whether the event was likely to have been affected through routine preoperative testing. Stratified analyses were performed to determine whether preoperative testing might have had differing consequences on the subgroups of patients.

accrues A total of 18,189 patients registered in the study. The sum of two units groups were well balanced in age, sex race, coexisting illness, American Society of Anesthesiologists (ASA) risk class, and self-reported health status. The cumulative rate of medical affairs was the same in the pair groups at 31.3 events by 1,000 surgical procedures. The representations of medical events were similar in as well-as; not only-but also; not only-but; not alone-but groups. Treatment for hypertension and arrhythmia accounted for 61% of the consequences in the no-test group and 68% in the routine-testing dispose The researchers found no benefit from routine preoperative medical testing when the analyses were stratified. No significant differences in the occurrence rates according to coexisting illness, ASA risk class, or self-reported health status were found

Discussion. This consideration supports the conclusion that perioperative morbidity and mortality are not reduc on routine use of preoperative medical proofs The rate of perioperative incidents was the same in as well-as; not only-but also; not only-but; not alone-but subgroups. This study did not find evidence that preoperative medical testing ariseed in the postponement or cancellation of surgery for patients lay the foundation of to be at risk for medical adventures The researchers believe that this meditation supports the need to eliminate the frequent practice of ordering routine medical experiments for patients undergoing cataract surgery They praise that tests be ordered solely when the history or a physical examination indicates the ne for a experiment even if surgery had not been planned. It is likely that greatest in quantity of the costs of routine preoperative testing can be saved without any negative validity on patients' health or clinical issues Individuals with the authority to make decisions in settings where cataract surgery is performed would do well to seriously consider this study

MARY LYNNE WEEMERING RN MSN CNOR NURSING RESEARCH COMMITTEE

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