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Ophthalmology

Cataracts: Unnecessary Preoperative Testing

August 26, 2016
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In spite of a bounty of evidence advising against it, over half of all Medicare patients that undergo cataract surgery still are subjected to unwarranted and unnecessary preoperative testing. The New England Journal of Medicine investigators who uncovered this trend say that such practices are non-beneficial yet add significantly to national healthcare costs.

These results come despite over a decade of universal public guidelines advising against routine preoperative tests on the grounds that they do not benefit the patient. What they do very effectively, however, is cost taxpayers money. It is estimated that over 800,000 tests were performed in the month prior to cataract surgery, costing a combined total of $16.1 million. In the same timeframe, Medicare patients made over 300,000 in-office visits, adding up to over $28 million in costs. Catherine L Chen, as the lead author of the study, laments that though the guidelines are publicly available, “physicians continue to order these tests at the same frequency as before the evidence based guidelines were introduced.” This suggests that doctors’ habits may be keeping them from adjusting their long-standing preoperative protocol to current standards.

The study that Chen and her colleagues undertook is complemented by a 2011 Anesthesiology study conducted by Philips et al, which demonstrated that 19% of ophthalmic surgery patients that underwent testing were found to have an abnormal condition necessitating additional testing. Only 2% of the total patients surveyed required surgery postponement due to findings from testing.

As the most common elective surgery for Medicare patients, who opt for the procedure nearly 1.7 million times a year, cataract surgery has the potential to be an area of cost-cutting for national healthcare costs. Yet Chen et al’s study shows that nearly 53% of cataract patients still undergo preoperative testing, while 52% partake in unnecessary visits prior to surgery. Notably, Chen and her team discovered that the most important deciding factor in whether patients underwent preoperative tests was not their condition but rather their physician. Certain physicians were much more apt to require preoperative testing regardless of patient condition, with 36% of physicians having over three-fourths of their patients undergo tests while nearly 8% of physicians require all of their patients to undergo pre-op tests. This points further to the potential that medical habit plays in the requirement of these tests. The results of this study, Chen hopes, will go a long way towards dismantling these unnecessary pre-operative testing habits that are not only bereft of benefit but costing the nation substantial amounts of tax dollars.

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