Lynchburg Journal of Medical Science

Lynchburg Journal of Medical Science


General Medicine


Dr. Elyse Watkins, DHSc, PA-C


Questioning the utility of routine preoperative medical evaluation for cataract surgery. Recent findings: Cataract surgery is a highly cost-effective approach for vision restoration with less than 1% risk of major adverse cardiac events or death, as such, routine testing does not help reduce the incidence of intraoperative medical complications. The Joint Commission and Center for Medicare and Medicaid Services mandate that every patient undergo a comprehensive medical history and physical examination (H&P) within 30 days prior to surgery, irrespective of the kind of surgery. An estimated 3 million cataract surgery are performed per annual in the United States, (Medicare beneficiaries and those who are under 65 years of age), with an associated cost of more than half a billion dollars each year (assuming a cost of $175 for H&P for each surgery). Summary: The shift from volume-based to value-based care has been one of the major focus in an effort to address the U.S health care crisis and the elimination of unnecessary or wasteful tests and the procedure is one approach to improving the value equation. The Choosing Wisely campaign major theme is the elimination of routine preoperative test in low-risk patients. The fact that 30 million Americans undergo surgery annually and about sixty percent undergo surgery almost exclusively as an outpatient or in an ambulatory center with the use of local anesthesia, sometimes in conjunction with intravenous sedation, the elimination of unnecessary preoperative tests and consolation represents an area of potentially large health care savings. Routine preoperative testing should not be recommended for patients undergoing cataract surgery because testing neither decreases adverse events nor improves outcomes.


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