title: The impact of preoperative evaluation on perioperative events in patients undergoing cataract surgery: a cohort study.
abstract: PurposeAmbulatory surgery is a major area of surgical and anesthetic practice, and preoperative clinics are being increasingly used for low-risk surgical procedures. This study investigated the impact of preoperative evaluation on perioperative events in patients undergoing cataract surgery.MethodsThis was a retrospective cohort study of 968 consecutive patients undergoing cataract surgery. Details of medical conditions, surgical, anesthetic, and postoperative information were collected from medical records. A logistic regression model was developed using propensity score adjustment for baseline characteristics.ResultsOut 968 patients included, 240 (24.7%) underwent outpatient preoperative evaluation. There were no perioperative major cardiovascular events. Hypertension occurred in 319 (33%) patients, accounting for 79.7% of all adverse events. Preoperative evaluation resulted in a lower hypertension rate after adjustment for propensity score (OR=0.6; 95% CI 0.41-0.93); no effects were observed on posterior capsule rupture and emergency visits/hospitalization within 7 days of surgery. Eighty-nine patients (9.3%) had an initial systolic pressure ≥180 mm Hg, which was not associated with higher risk of posterior capsule rupture (P=0.158) or postoperative adverse events (P=0.902). Median waiting time to surgery was 6 and 2 months for evaluated and non-evaluated patients, respectively (P<0.001).ConclusionsIn the context of low-risk surgery and no major perioperative and postoperative outcomes, it appears that outpatient preoperative evaluation has no role in reducing adverse events in cataract surgery candidates. Despite fewer hypertensive episodes observed in evaluated patients, these episodes were not associated with any medical or surgical outcomes.
authors.affiliation: Department of Anaesthesiology, Perioperative and Pain Medicine (SAMPE), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.
authors.forename: C
authors.initials: C
authors.lastname: Alboim
authors.affiliation: Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
authors.forename: R B
authors.initials: RB
authors.lastname: Kliemann
authors.affiliation: Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
authors.forename: L E
authors.initials: LE
authors.lastname: Soares
authors.affiliation: Department of Anaesthesiology, Perioperative and Pain Medicine (SAMPE), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.
authors.forename: M M
authors.initials: MM
authors.lastname: Ferreira
authors.affiliation: Department of Internal Medicine, Division of Cardiology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.|Post - Graduate Program in Cardiology, School of Medicine, UFRGS, Porto Alegre, Brazil.|Institute for Health Technology Assessment (IATS), HCPA, Porto Alegre, Brazil.
authors.forename: C A
authors.initials: CA
authors.lastname: Polanczyk
authors.affiliation: Department of Internal Medicine, Division of Cardiology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.|Post - Graduate Program in Cardiology, School of Medicine, UFRGS, Porto Alegre, Brazil.|Institute for Health Technology Assessment (IATS), HCPA, Porto Alegre, Brazil.
authors.forename: A
authors.initials: A
authors.lastname: Biolo
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D002387:Cataract Extraction / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies