The Value of Routine Preoperative Medical Testing before Cataract Surgery
Oliver D. Schein, M.D., M.P.H., Joanne Katz, Sc.D., Eric B. Bass, M.D., M.P.H., James M. Tielsch, Ph.D., Lisa H. Lubomski, Ph.D., Marc A. Feldman, M.D., M.P.H., Brent G. Petty, M.D., Earl P. Steinberg, M.D., M.P.P., for The Study of Medical Testing for Cataract Surgery
Background Routine preoperative medical testing is commonlyperformed in patients scheduled to undergo cataract surgery,although the value of such testing is uncertain. We performeda study to determine whether routine testing helps reduce theincidence of intraoperative and postoperative medical complications.
Methods We randomly assigned 19,557 elective cataract operationsin 18,189 patients at nine centers to be preceded or not precededby 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 historytaking and physical examination. Adverse medical events andinterventions on the day of surgery and during the seven daysafter surgery were recorded.
Results Medical outcomes were assessed in 9408 patients whounderwent 9626 cataract operations that were not preceded byroutine testing and in 9411 patients who underwent 9624 operationsthat were preceded by routine testing. The most frequent medicalevents in both groups were treatment for hypertension and arrhythmia(principally bradycardia). The overall rate of complications(intraoperative and postoperative events combined) was the samein the two groups (31.3 events per 1000 operations). There werealso no significant differences between the no-testing groupand the testing group in the rates of intraoperative events(19.2 and 19.7, respectively, per 1000 operations) and postoperativeevents (12.6 and 12.1 per 1000 operations). Analyses stratifiedaccording to age, sex, race, physical status (according to theAmerican Society of Anesthesiologists classification), and medicalhistory revealed no benefit of routine testing.
Conclusions Routine medical testing before cataract surgerydoes 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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