title: Safety and comparative costs of preoperative assessments for cataract surgery: traditional mandatory assessment versus a novel graded assessment system.
abstract: OBJECTIVE
  We conducted this study to evaluate the safety and costs of traditional mandatory preoperative assessment for cataract surgery patients compared with a novel graded preoperative assessment system.
  
  
  METHODS
  Patients were recruited at a high-volume surgical centre from May to November 2013. Patients completed a health-related questionnaire which allowed for a graded preoperative assessment of all participants. Based on responses to the questionnaire, patients were classified preoperatively into a) low-risk patients not requiring a preoperative assessment and b) high-risk patients requiring this assessment. Anesthesiologists still assessed all patients immediately before surgery but with staff blinded to preoperative assessment information for low-risk patients. Observed complication rates and costs were compared with those expected in the mandatory assessment system.
  
  
  RESULTS
  We examined 3,347 cataract surgeries on 2,766 patients and categorized 59.9% of patients as low risk. In the graded system cohort, there were no major complications and a low rate of minor complications occurred. Wherever a complication occurred in a low-risk patient, the anesthesiologist doubted that the preoperative assessment information would have prevented the complication. If implemented, the graded system would save approximately 4,414 preoperative assessments per year in our region, with an associated cost of approximately $40.00 per surgery, or $359,000 in total. The cost to prevent a single minor complication with the mandatory system was approximately $8,976, with a number needed to treat of 223.
  
  
  CONCLUSIONS
  The graded system resulted in no major complications and a low rate of minor complications. The information obtained from the mandatory assessment is unlikely to prevent complications. Additionally, the cost effectiveness of the mandatory system was poor. This novel graded preoperative assessment system for cataract surgery patients can save time and resources by eliminating unnecessary patient visits.
authors.affiliation: Department of Ophthalmology, University of Manitoba and Misericordia Health Centre, Room M264, 99 Cornish Avenue, Winnipeg, MB, R3T 2N2, Canada. umjastra@myumanitoba.ca.
authors.forename: André
authors.identifier: http://orcid.org/0000-0002-2758-8647
authors.initials: A
authors.lastname: Jastrzebski
authors.affiliation: Department of Anesthesia, University of Manitoba and Misericordia Health Centre, Winnipeg, MB, Canada.
authors.forename: Alex
authors.initials: A
authors.lastname: Villafranca
authors.affiliation: Department of Anesthesia, University of Manitoba and Misericordia Health Centre, Winnipeg, MB, Canada.
authors.forename: Subash
authors.initials: S
authors.lastname: Sethi
authors.affiliation: Department of Ophthalmology, University of Manitoba and Misericordia Health Centre, Room M264, 99 Cornish Avenue, Winnipeg, MB, R3T 2N2, Canada.
authors.forename: Lorne
authors.initials: L
authors.lastname: Bellan
mesh_terms: D000368:Aged; D002387:Cataract Extraction / Q000191:economics* / Q000379:methods*; D003362:Cost-Benefit Analysis / Q000191:economics* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000009:adverse effects* / Q000191:economics* / Q000379:methods