The value of routine preoperative medical testing before cataract surgery

被引:317
|
作者
Schein, OD
Katz, J
Bass, EB
Tielsch, JM
Lubomski, LH
Feldman, MA
Petty, BG
Steinberg, EP
机构
[1] Johns Hopkins Univ, Wilmer Eye Inst, Dana Ctr Prevent Ophthalmol, Baltimore, MD 21218 USA
[2] Johns Hopkins Univ, Dept Med, Div Gen Internal Med, Baltimore, MD USA
[3] Johns Hopkins Univ, Dept Anesthesiol, Baltimore, MD USA
[4] Johns Hopkins Univ, Dept Med, Div Clin Pharmacol, Baltimore, MD USA
[5] Johns Hopkins Univ, Sch Hyg & Publ Hlth, Baltimore, MD USA
[6] Covance Hlth Econ & Outcomes Serv, Washington, DC USA
来源
NEW ENGLAND JOURNAL OF MEDICINE | 2000年 / 342卷 / 03期
关键词
D O I
10.1056/NEJM200001203420304
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Routine preoperative medical testing is commonly performed in patients scheduled to undergo cataract surgery, although the value of such testing is uncertain. We performed a study to determine whether routine testing helps reduce the incidence of intraoperative and postoperative medical complications. Methods We randomly assigned 19,557 elective cataract operations in 18,189 patients at nine centers to be preceded or not preceded by a standard battery of medical tests (electrocardiography, complete blood count, and measurement of serum levels of electrolytes, urea nitrogen, creatinine, and glucose), in addition to a history taking and physical examination. Adverse medical events and interventions on the day of surgery and during the seven days after surgery were recorded. Results Medical outcomes were assessed in 9408 patients who underwent 9626 cataract operations that were not preceded by routine testing and in 9411 patients who underwent 9624 operations that were preceded by routine testing. The most frequent medical events in both groups were treatment for hypertension and arrhythmia (principally bradycardia). The overall rate of complications (intraoperative and postoperative events combined) was the same in the two groups (31.3 events per 1000 operations). There were also no significant differences between the no-testing group and the testing group in the rates of intraoperative events (19.2 and 19.7, respectively, per 1000 operations) and postoperative events (12.6 and 12.1 per 1000 operations). Analyses stratified according to age, sex, race, physical status (according to the American Society of Anesthesiologists classification), and medical history revealed no benefit of routine testing. Conclusions Routine medical testing before cataract surgery does not measurably increase the safety of the surgery. (N Engl J Med 2000;342:168-75.) (C) 2000, Massachusetts Medical Society.
引用
收藏
页码:168 / 175
页数:8
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