Preoperative Testing Could Be a Waste of Time and Money
WebMD News Archive
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.