Preoperative Testing Ineffective in Cataract Surgery

Preoperative testing before general ophthalmologic surgery does not significantly affect outcomes and complications, a study published in The American Journal of Medicine shows.

Prior research has found that preoperative tests do not accurately predict adverse events in cataract surgery. The researchers said this is the first study to compare the impact of preoperative testing of patients undergoing cataract surgery and patients undergoing noncataract surgery.

The investigators reviewed outcomes and any ocular and systemic adverse events that occurred before or during ophthalmological surgeries that 2268 adult patients underwent between 2015 and 2019. The procedures included cataract, vitreoretinal, glaucoma correction, and oculoplastic surgeries, and ocular radioactive implants and ocular biopsies. The investigators categorized preoperative testing results as normal or abnormal. Interventions in the 120 days prior to the planned date of surgery and adverse events at the time of discharge and at 24 hours, 30 days, and 180 days after surgery were included.

The mean age of the cohort was 69.5±10.9 years. Surgeries included cataract extraction (63.9%), oculoplastic (12.1%), glaucoma correction (16.3%) and retinal surgery (7.8%). 

Of the 1261 patients (489/1,450 (33.7%) cataract, 772/818 noncataract (94.4%) with laboratory test results, 659 had abnormal laboratory test results (275 cataract, 384 noncataract), which included glomerular filtration rate (19.7%), anemia (16.6%), and elevated glycated hemoglobin A_1c (11.9%) and 28 (17 cataract, 10 noncataract) had abnormal results that required intervention.

The 12 patients who experienced complications underwent preoperative testing, and none of the patients who did not undergo preoperative testing had complications (P =.002). 

There were no differences between cataract and noncataract groups in surgery cancellations (n=16) and delays (n=6).

Type and frequency of complications were not significantly different between the cataract and noncataract surgery groups. Complications and abnormal test values were not linked in either the cataract group or the noncataract group, the researchers reported. Twelve patients experienced postoperative complications, which were primarily ophthalmologic concerns (41.7%) and thromboembolic events (25%). 

“More studies are necessary to establish evidence-based guidelines regarding preoperative testing for patients undergoing noncataract ophthalmologic surgical procedures, but elimination of routine testing for this patient group could save the health care system hundreds of millions of dollars per year if preoperative laboratory tests are ordered on the basis of an individual patient’s clinical history and physical examination findings,” according to the investigators.

Limitations of the study related to generalizability and the retrospective nature of the study.

Reference

Irizarry-Alvarado JM, Beltran M, Motoa G, et al. Impact of preoperative testing on patients undergoing ophthalmologic surgery: a retrospective cohort study. Am J Medicine. Published online August 21, 2021. doi:10.1016/j.amjmed.2021.07.034