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Previous Volume 342:168-175 January 20, 2000 Number 3 Next

	Full Text PDF Editorial by Roizen, M. F. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Routine preoperative medical testing is commonly performed in patients scheduled to undergo cataract surgery, although the value of such testing is uncertain. We performed a study to determine whether routine testing helps reduce the incidence of intraoperative and postoperative medical complications.

Methods We randomly assigned 19,557 elective cataract operations in 18,189 patients at nine centers to be preceded or not preceded by a standard battery of medical tests (electrocardiography, complete blood count, and measurement of serum levels of electrolytes, urea nitrogen, creatinine, and glucose), in addition to a history taking and physical examination. Adverse medical events and interventions on the day of surgery and during the seven days after surgery were recorded.

Results Medical outcomes were assessed in 9408 patients who underwent 9626 cataract operations that were not preceded by routine testing and in 9411 patients who underwent 9624 operations that were preceded by routine testing. The most frequent medical events in both groups were treatment for hypertension and arrhythmia (principally bradycardia). The overall rate of complications (intraoperative and postoperative events combined) was the same in the two groups (31.3 events per 1000 operations). There were also no significant differences between the no-testing group and the testing group in the rates of intraoperative events (19.2 and 19.7, respectively, per 1000 operations) and postoperative events (12.6 and 12.1 per 1000 operations). Analyses stratified according to age, sex, race, physical status (according to the American Society of Anesthesiologists classification), and medical history revealed no benefit of routine testing.

Conclusions Routine medical testing before cataract surgery does not measurably increase the safety of the surgery.

Source Information

From the Dana Center for Preventive Ophthalmology, Wilmer Eye Institute (O.D.S., J.K., J.M.T., L.H.L.), the Division of General Internal Medicine, Department of Medicine (E.B.B., B.G.P., E.P.S.), the Department of Anesthesiology (M.A.F.), the Division of Clinical Pharmacology, Department of Medicine (B.G.P.), and the School of Hygiene and Public Health (J.K., J.M.T.), Johns Hopkins University, Baltimore; and Covance Health Economics and Outcomes Services, Washington, D.C. (E.P.S.).

Address reprint requests to Dr. Schein at 116 Wilmer Bldg., Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21287-9019, or at oschein{at}jhmi.edu.

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