Preoperative Cataract Testing Trends Contradict Guidelines

Fifty-three percent of Medicare beneficiaries scheduled for cataract surgery underwent preoperative testing despite guidelines advising not to, according to a recent study.

“Routine preoperative testing is not recommended for patients undergoing cataract surgery, because testing neither decreases adverse events nor improves outcomes,” wrote the study’s authors.
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“We sought to assess adherence to this guideline, estimate expenditures from potentially unnecessary testing, and identify patient and health care system characteristics associated with potentially unnecessary testing,” they explained.

For the study, researchers compared the frequency of preoperative testing and office visits with the average number of Medicare beneficiaries who underwent tests during the 11 months preceding their surgery.

Of the 440,857 patients who were examined, 53% underwent at least 1 preoperative test during the month prior to surgery. During that month, test expenditures reached $4.8 million (42%) higher and office visit expenditures were $12.4 million more (78%) than the mean monthly expenses during the preceding 11 months.

Investigators noted that patients were more likely to undergo testing if their ophthalmologist who managed their preoperative evaluation recommended or supported the procedures.

The complete study is published in the April issue of the New England Journal of Medicine.

-Michelle Canales Butcher

Reference:

Chen CL, Lin GA, Bardach N, et al. Preoperative medical testing in medicare patients undergoing cataract surgery. NJEM. 2015 April [epub ahead of print] doi: 10.1056/NEJMsa1410846.