Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2012 Mar 14;3(3):CD007293.
doi: 10.1002/14651858.CD007293.pub3.

Routine preoperative medical testing for cataract surgery

Lisa Keay  1 , Kristina Lindsley, James Tielsch, Joanne Katz, Oliver Schein
Affiliations
Meta-Analysis

Routine preoperative medical testing for cataract surgery

Lisa Keay et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Cataract surgery is practiced widely and substantial resources are committed to an increasing cataract surgical rate in developing countries. With the current volume of cataract surgery and the increases in the future, it is critical to optimize the safety and cost-effectiveness of this procedure. Most cataracts are performed on older individuals with correspondingly high systemic and ocular comorbidities. It is likely that routine preoperative medical testing will detect medical conditions, but it is questionable whether these conditions should preclude individuals from cataract surgery or change their perioperative management.

Objectives: (1) To investigate the evidence for reductions in adverse events through preoperative medical testing, and (2) to estimate the average cost of performing routine medical testing.

Search methods: We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2011, Issue 12), MEDLINE (January 1950 to December 2011), EMBASE (January 1980 to December 2011), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to December 2011), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 9 December 2011. We used reference lists and the Science Citation Index to search for additional studies.

Selection criteria: We included randomized clinical trials in which routine preoperative medical testing was compared to no preoperative or selective preoperative testing prior to age-related cataract surgery.

Data collection and analysis: Two review authors independently assessed abstracts to identify possible trials for inclusion. For each included study, two review authors independently documented study characteristics, extracted data, and assessed methodological quality.

Main results: The three randomized clinical trials included in this review reported results for 21,531 total cataract surgeries with 707 total surgery-associated medical adverse events, including 61 hospitalizations and three deaths. Of the 707 medical adverse events reported, 353 occurred in the pretesting group and 354 occurred in the no testing group. Most events were cardiovascular and occurred during the intraoperative period. Routine preoperative medical testing did not reduce the risk of intraoperative (OR 1.02, 95% CI 0.85 to 1.22) or postoperative medical adverse events (OR 0.96, 95% CI 0.74 to 1.24) when compared to selective or no testing. Cost savings were evaluated in one study which estimated the costs to be 2.55 times higher in those with preoperative medical testing compared to those without preoperative medical testing. There was no difference in cancellation of surgery between those with preoperative medical testing and those with no or limited preoperative testing, reported by two studies.

Authors' conclusions: This review has shown that routine pre-operative testing does not increase the safety of cataract surgery. Alternatives to routine preoperative medical testing have been proposed, including self-administered health questionnaires, which could substitute for health provider histories and physical examinations. Such avenues may lead to cost-effective means of identifying those at increased risk of medical adverse events due to cataract surgery. However, despite the rare occurrence, adverse medical events precipitated by cataract surgery remain a concern because of the large number of elderly patients with multiple medical comorbidities who have cataract surgery in various settings. The studies summarized in this review should assist recommendations for the standard of care of cataract surgery, at least in developed settings. Unfortunately, in developing country settings, medical history questionnaires would be useless to screen for risk since few people have ever been to a physician, let alone been diagnosed with any chronic disease.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Funnel plot of comparison: 1 Preoperative testing versus selective or no preoperative testing, outcome: 1.1 Total intraoperative medical adverse events.
Figure 2
Figure 2
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

    1. Cavallini GM, Saccarola P, D'Amico R, Gasparin A, Campi L. Impact of preoperative testing on ophthalmologic and systemic outcomes in cataract surgery. European Journal of Ophthalmology. 2004;14(5):369–74. - PubMed
    1. Arieta CE, Nascimento MA, Lira RP, Kara-Jose N. Waste of medical tests in preoperative evaluation for cataract surgery [Desperdício de exames complementares na avaliação pré–operatória em cirurgias de catarata] Cadernos de Saude Publica. 2004;20(1):303–10. - PubMed
    1. Lira RP. Tese de Doutorado (Doctoral Thesis) Campinas: Faculdade de Ciências Médicas da UNICAMP; 2002. Preoperative tests in ambulatory cataract surgery in adults: Is a routine necessary? [Testes pré–operatórios na cirurgia de cataracta ambulatorial em adultos: É necessária uma rotina?]
    1. Lira RP, Nascimento MA, Moreira-Filho DC, Kara-Jose N, Arieta CE. Are routine preoperative medical tests needed with cataract surgery? Pan American Journal of Public Health. 2001;10(1):13–7. - PubMed
    1. Nascimento MA, Lira RP, Kara-Jose N, Arieta CE. Predictive value of preoperative fasting glucose test of diabetic patients regarding surgical outcome in cataract surgery [Valor preditivo da glicemia de jejum pré–operatória de pacientes diabéticos quanto ao resultado cirúrgico da cirurgia de catarata] Arquivos Brasileiros de Oftalmologia. 2005;68(2):213–7. - PubMed

References to studies excluded from this review

    1. Blery C, Szatan M, Fourgeaux B, Charpak Y, Darne B, Chastang CL, et al. Evaluation of a protocol for selective ordering of preoperative tests. Lancet. 1986;1(8473):139–41. - PubMed
    1. Brown MM. The value of routine preoperative medical testing before cataract surgery. Evidence-Based Eye Care. 2001;2(3):186–7.
    1. Bruns DE. Laboratory-related outcomes in healthcare. Clinical Chemistry. 2001;47(8):1547–52. - PubMed
    1. Coleman AL. Applying evidence-based medicine in ophthalmic practice. American Journal of Ophthalmology. 2002;134(4):599–601. - PubMed
    1. Francis JG, Barker JP. Postoperative morbidity following cataract surgery. Anaesthesia. 1996;51(9):888–9. - PubMed

Additional references

    1. American Academy of Ophthalmology. Cataract in the adult eye, Preferred Practice Pattern. [accessed 2 October 2008]; http://one.aao.org/CE/PracticeGuidelines/PPP_Content.aspx?cid=a80a87ce-9....
    1. Eagle KA, Berger PB, Calkins H, Chaitman BR, Ewy GA, Fleischmann KE, et al. ACC/AHA guideline update on perioperative cardiovascular evaluation for noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee to update the 1996 Guidelines on perioperative cardiovascular evaluation for noncardiac surgery) [accessed 2 October 2008]; acc.org/clinical/guidelines/perio/dirIndex.htm. - PubMed
    1. American Society of Anesthesiologists Task Force on Preanesthesia Evaluation. Practice advisory for preanesthesia evaluation: a report by the American Society of Anesthesiologists Task Force on preanesthesia evaluation. Anesthesiology. 2002;96(2):485–96. - PubMed
    1. Bass EB, Steinberg EP, Luthra R, Schein OD, Tielsch JM, Javitt JC, et al. Do ophthalmologists, anesthesiologists, and internists agree about preoperative testing in healthy patients undergoing cataract surgery? Archives of Ophthalmology. 1995;113(10):1248–56. - PubMed
    1. Bellan L. Preoperative testing for cataract surgery. Canadian Journal of Ophthalmology. 1994;29(3):111–4. - PubMed

References to other published versions of this review

    1. Keay L, Lindsley K, Tielsch J, Katz J, Schein O. Routine preoperative medical testing for cataract surgery. Cochrane Database of Systematic Reviews. 2009;(2) doi: 10.1002/14651858.CD007293.pub2. - DOI - PMC - PubMed

Publication types

MeSH terms