A Preoperative Medical History and Physical Should Not Be a Requirement for All Cataract Patients.
Cataract surgery poses minimal systemic medical risk, yet a preoperative general medical history and physical is required by the Centers for Medicare and Medicaid Services and other regulatory bodies within 1 month of cataract surgery. Based on prior research and practice guidelines, there is professional consensus that preoperative laboratory testing confers no benefit when routinely performed on cataract surgical patients. Such testing remains commonplace. Although not yet tested in a large-scale trial, there is also no evidence that the required history and physical yields a benefit for most cataract surgical patients above and beyond the screening performed by anesthesia staff on the day of surgery. We propose that the minority of patients who might benefit from a preoperative medical history and physical can be identified prospectively. Regulatory agencies should not constrain medical practice in a way that adds enormous cost and patient burden in the absence of value.
Department of Ophthalmology, Johns Hopkins School of Medicine, 600 N. Wolfe St., Baltimore, MD, 21287-9019, USA. oschein@jhmi.edu.
Oliver D
OD
Schein
Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD, USA.|Departments of Anesthesiology & Critical Care Medicine, Surgery, and Health Policy and Management, Johns Hopkins University, Baltimore, MD, USA.
Peter J
PJ
Pronovost
D002386:Cataract / Q000175:diagnosis*; D002387:Cataract Extraction / Q000331:legislation & jurisprudence / Q000379:methods*; D006801:Humans; D008487:Medical History Taking / Q000379:methods*; D010808:Physical Examination / Q000379:methods*; D011300:Preoperative Care / Q000331:legislation & jurisprudence / Q000379:methods*
cataract surgery; preoperative evaluation; risk assessment