Journal of General Internal Medicine

, Volume 32, Issue 7, pp 813–814 | Cite as

A Preoperative Medical History and Physical Should Not Be a Requirement for All Cataract Patients

Perspective

Abstract

Cataract surgery poses minimal systemic medical risk, yet a preoperative general medical history and physical is required by the Centers for Medicare and Medicaid Services and other regulatory bodies within 1 month of cataract surgery. Based on prior research and practice guidelines, there is professional consensus that preoperative laboratory testing confers no benefit when routinely performed on cataract surgical patients. Such testing remains commonplace. Although not yet tested in a large-scale trial, there is also no evidence that the required history and physical yields a benefit for most cataract surgical patients above and beyond the screening performed by anesthesia staff on the day of surgery. We propose that the minority of patients who might benefit from a preoperative medical history and physical can be identified prospectively. Regulatory agencies should not constrain medical practice in a way that adds enormous cost and patient burden in the absence of value.

KEY WORDS

cataract surgery preoperative evaluation risk assessment 

References

  1. 1.
    Schein OD, Cassard SD, Tielsch JM, Gower EW. Cataract surgery among Medicare beneficiaries. Ophthalmic Epidemiol. 2012;19:257–64.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Schein OD, Katz J, Bass EB, et al. Study of Medical Testing for Cataract Surgery. The value of routine preoperative medical testing before cataract surgery. N Engl J Med. 2000;342(3):168–75.CrossRefPubMedGoogle Scholar
  3. 3.
    Chen CL, Lin GA, Bardach NS, et al. Preoperative medical testing in Medicare patients undergoing cataract surgery. N Engl J Med. 2015;372:1530–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Bass EB, Steinberg EP, Luthra R, et al. Do ophthalmologists, anesthesiologists and internists agree about preoperative testing in healthy patients undergoing cataract surgery? Arch Ophthalmol. 1995;113:1248–56.CrossRefPubMedGoogle Scholar
  5. 5.
    Cassel CK, Guest JA. Choosing wisely: helping physicians and patients make smart decisions about their care. JAMA. 2012;307(17):1801–1802.CrossRefPubMedGoogle Scholar
  6. 6.
    CMS Manual System. Available at:https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R71SOMA.pdf; Accessed February 25, 2017.
  7. 7.
    Thilen SR, Treggiari MM, Lange JM, et al. Preoperative consultations for Medicare patients undergoing cataract surgery. JAMA Intern Med. 2014;174(3):380–388.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Fleisher LA. Preoperative consultation before cataract surgery. Are we choosing wisely or is this simply low-value care? JAMA Intern Med. 2014;174(3):389–90.CrossRefPubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine 2017

Authors and Affiliations

  1. 1.Department of OphthalmologyJohns Hopkins School of MedicineBaltimoreUSA
  2. 2.Armstrong Institute for Patient Safety and QualityJohns Hopkins MedicineBaltimoreUSA
  3. 3.Departments of Anesthesiology & Critical Care Medicine, Surgery, and Health Policy and ManagementJohns Hopkins UniversityBaltimoreUSA

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