مجله دانشکده پزشکی اصفهان (Mar 2012)
Assessment of Patients before Cataract Surgery: Are Routine Tests Cost-Effective?
Abstract
Background: Cataract surgery is considered as one of the low-risk and low-stress surgeries. Preoperative examination by an anesthesiologist is an integral and necessary part of every surgery to reduce mortality rate, complications, costs, and hospitalization duration. However, the quality and quantity of cataract preoperative assessment are controversial. On one hand, a large number of routine clinical tests would lead to a prolonged and costly process of treatment. On the other hand, because most patients are elderly with poor general health status, taking non-scientific risks and inappropriate preoperative assessment do not make sense. The present study aimed to determine the value of routine tests before cataract surgery by reviewing their potential advantages and disadvantages. Methods: This prospective analytical study was conducted in Feiz Educational Hospital and Aban Ophthalmology Clinic (Isfahan, Iran) in 2010 and 2011. It included 700 cataract patients with physical status grades 1-3 (according to the rating of American Society of Anesthesiologists). Local anesthesia was used in all patients. They all aged over 25 years old. The patients were divided into two groups (n = 350 in each group) and underwent preoperative assessments. The first group underwent routine tests such as echocardiography (ECG), and complete blood cell (CBC) count, blood sugar (BS), blood urea nitrogen (BUN), and creatinine (Cr) tests. However, no tests, expect history taking and physical examination, were performed on the second group. Therefore, subjects over 40 with a history of cardiac diseases underwent ECG. Diabetic patients also underwent a BS test using a glucometer. Afterwards, 11 perioperative and 11 postoperative complications were evaluated in both groups. The complications included nausea and vomiting, sweating, severe lethargy, dysrhythmia, hypotension, hypertension, ischemic heart disease (IHD), O2 saturation drop, apnea, and death. The costs of the assessments were also calculated for both groups. Data was analyzed by t-test, chi-square test, Kendall's Tau correlation analysis and logistic regression model in SPSS16. Findings: The findings of the study showed that out of 11 complications during the surgery, the two groups were only significantly different in hypertension which was more prevalent in the group with more routine tests. In addition, out of 11 postoperative complications, the only significant difference between the two groups was in nausea which occurred more in the group without routine tests. Comparing the mean complications of the two groups showed no significant difference (P = 0.451). Costs in the group with routine tests were almost 7 times higher than the other group. Conclusion: Removing routine tests and replacing them with necessary tests (in many cases only two tests and in some other cases no test was required), will significantly reduce costs and thus result in higher patient satisfaction. On the other hand, cataract surgery is a highly prevalent procedure for most costs of which the government takes the responsibility. Therefore, since routine tests are not cost-effective, by eliminating their useless costs, a considerable and significant saving will occur in macro-level.
