Overuse of preoperative testing tied to delayed cataract surgery, patient falls

Researchers assessed whether the use of routine preoperative testing leads to delayed surgery and falls in Medicare beneficiaries awaiting cataract surgery.

Study design

This retrospective, observational cohort study reviewed the Medicare claims of 248,345 patients—5% sample of the total data set—aged 66 years or older who had current procedural terminology claims submitted for ocular biometry between 2006 and 2014. The authors measured the number of days between biometry and cataract surgery, calculated the percentage of patients who waited more than 30 or 90 days for surgery, and determined the odds of falling within 90 days of biometry. They calculated these values for patients of high-testing physicians (performing routine preoperative testing in >75% of patients within 30 days prior to surgery) and low-testing physicians.

Outcomes

Approximately 16% of the cohort were patients of high-testing physicians. Compared with individuals managed by low-testing physicians, patients of high-testing physicians tended to wait more than 30 days (31% vs. 25%) or 90 days (8% vs. 6%) to undergo cataract surgery. Patients of high-testing physicians were also more likely to fall within 90 days of biometry (OR 1.1) and have an 8-day delay to surgery. Other factors associated with delay were patient race (non-White), care in the Northeast region, ophthalmologists aged 40 years or younger and low surgical volume.

Limitations

This study used retrospective data relying on the date that biometry was obtained to determine the timing of surgical delay. This assumes that patients want to schedule surgery immediately after having biometry testing. However, many patients like to schedule their cataract surgery several months in advance for a variety of reasons such as weather, travel plans, social obligations, unexpected medical illness or other upcoming medical procedures. Since biometry may be obtained many months before the planned cataract surgery, the lag time between the physician submitting the biometry billing claim and the surgical date cannot be attributed entirely to the physician's preoperative testing practice patterns.

Clinical significance

This study correlates delay in surgical scheduling due to routine preoperative testing with the risk of the patient falling. Over the past several years, routine preoperative testing has been decreasing and is expected to decrease even further in the next several years. The surgical scheduling process could be streamlined further as physicians become more comfortable with the concept of risk stratification and selectively sending higher-risk patients for preoperative testing with another healthcare provider.