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  • The Downside of Pre-Op Testing for Cataract Surgery

    By Lynda Seminara
    Selected By: Stephen D. McLeod, MD
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    Journal Highlights

    Ophthalmology, February 2021

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    Patients scheduled for cataract surgery have a higher risk of falls if their surgery is delayed, but the effect of delays due to preoperative testing is not known. Chen et al. reviewed nine years of claims data to explore whether testing practice leads to harm for those patients who are awaiting cataract surgery. They found that pre-op medical testing often is overused and thereby may increase the like­lihood that fall-related harm will occur before cataract surgery takes place.

    This study included a 5% sample of Medicare beneficiaries (>65 years of age) who had undergone ocular biometry in the period 2006-2014. The authors gathered data and calculated the mean and median number of days between biometry and cataract surgery, as well as the proportion ofpatients who wait­ed ≥30 days and ≥90 days for their surgery and the number who had a fall within 90 days of biometry.

    Physicians were categorized as “high testing” or “low testing” according to the percentage of their patients who underwent biometry (≥75% or <75%, respectively), and the number of “delay days” was estimated for each group. Main outcomes were the incidence of falls between biometry and surgery, the odds of falling within 90 days of biom­etry, and the delay time associated with high and low testing levels.

    Among the 248,345 beneficiaries in the study, 16.4% were patients of high-testing physicians. Of these 31.4% waited ≥30 days and 25% waited ≥90 days for their surgery, versus 8.2% and 5.5%, respectively, of those treated by low-testing physicians. Among patients of high-testing physicians, a 43% increase in “fall events” occurred prior to surgery in the 90 days following biometry (1.0% vs. 0.7%; p < .0001). The adjusted odds ratio for falling within 90 days of biometry in patients of high-testing versus low-testing physicians was 1.10 (95% confidence interval [CI], 1.03-1.19; p = .008). After adjusting for surgical wait time, the odds ratio became 1.07 (95% CI, 1.00-1.15; p = .06). The delay for patients of high-level testers was 7.97 days longer than for patients of low-level testers (95% CI, 6.40-9.55 days; p < .0001).

    Other factors linked to surgical delay included patient race (non-White), Northeast U.S. location, younger ophthalmologist (≤40 years of age), and lower surgical volume.

    The original article can be found here.