The Value of Routine Preoperative Medical Testing before Cataract Surgery
Open accessAbstract
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.
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A randomized control study of over 19,000 cataract patients found no benefit to routine pre-operative medical testing when stratified according to age, gender, or race of the patient, and most abnormalities in laboratory values could be predicted from patient's history and physical exam.
“A randomized control study (RCT) of over 19,000 cataract patients found no benefit to routine pre-operative medical testing when stratified according to age, gender, or race of the patient, and most abnormalities in laboratory values could be predicted from patient’s history and physical exam [4].”
Reports continue to document unnecessary routine test ordering.
“Yet, reports continue to document unnecessary routine test ordering [2,4,6,10,31-33]”
There has been a large body of work reporting pre-operative testing practices.
“There has been a large body of work reporting pre-operative testing practices [2,4,6,10,31-33].”
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- Authors
- Schein, O. D., Katz, J., Bass, E. B., Tielsch, J. M., Lubomski, L. H., Feldman, M. A., Petty, B. G., & Steinberg, E. P.
- Affiliations
- Johns Hopkins University (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2000-01-20
- Volume
- 342
- Issue
- 3
- Pages
- 168-175
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W3023584084
- Cited by
- 526
- References
- 16
- Citations by year
- 2026: 8 · 2025: 8 · 2024: 12 · 2023: 13 · 2022: 11 · 2021: 20 · 2020: 17 · 2019: 22 · 2018: 24 · 2017: 27 · 2016: 27 · 2015: 16 · 2014: 25 · 2013: 31 · 2012: 36
- FWCI
- 14.87
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Agency for Healthcare Research and Quality (R01-HSO-8331)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
- Health Sciences › Medicine › Ophthalmology › Intraocular Surgery and Lenses
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Keywords
- cataract surgery, routine laboratory testing, intraoperative complications, postoperative complications, surgical safety, electrocardiogram, bradycardia, hypertension, cardiac arrhythmias, American Society of Anesthesiologists physical status
- MeSH terms
- Aged, Aged, 80 and over, Cataract Extraction, Diagnostic Tests, Routine, Female, Humans, Intraoperative Complications, Male, Medical History Taking, Middle Aged, Physical Examination, Postoperative Complications, Preoperative Care, Prospective Studies, Cross-Over Studies
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