Preoperative Testing Could Be a Waste of Time and Money
According to the study, the federal Health Care Financing Administration, which runs Medicare, spends $150 million annually on routine preoperative tests done before cataract surgery. Based on surveys with ophthalmologists, anesthesiologists, and internists, the authors write that these preoperative tests usually consist of complete blood counts, serum electrolyte measurements, and electrocardiograms (ECGs). In 1996, the most recent year for which statistics are available, some 1.5 million beneficiaries underwent cataract surgery, which the authors describe as "the most commonly performed operation in elderly people in developed countries."
The study compared the adverse events associated with more than 9,400 patients who had preoperative tests with the same number of patients who did not have preoperative tests. Patients were given a letter and study brochure to bring to their provider. Those in the no-testing group were to receive preoperative studies only if they "presented with a new or worsening medical problem that would warrant medication evaluation with testing, even if surgery were not planned," write the authors. Prior to surgery, those in the testing group were given a complete blood count, and measurements of serum electrolytes, urea nitrogen, creatinine, and glucose were taken.
Cumulatively, both groups experienced adverse events in 3% of surgeries. There was no significant difference in the number of adverse events for the testing group vs. the no-testing group. The most common events were high blood pressure and irregular heart rates. "Our study demonstrates that perioperative morbidity and morality are not reduced by routine use of commonly ordered preoperative medical tests," the authors write, adding that they "found no benefit of routine preoperative medical testing ... according to the participating center or the age, sex, or race of the patient."
While he praised the study, one prominent researcher also expressed "fear" about the possible misinterpretation of the findings. Michael F. Roizen, MD, chairman of the department of anesthesiology and critical care medicine at the University of Chicago, who wrote an editorial that was published with the study, tells WebMD he is not confident that routine physicals and medical histories are being taken or that these will be paid for if testing is abandoned.