Preop testing for low-risk cataract surgery patients: Choosing wisely or low-value care? Penn Medicine

December 23, 2013

(PHILADELPHIA) - The elimination of extensive routine preoperative tests and consultations represents an area of potentially large health care savings across many disciplines, particularly for low-risk patients being evaluated for cataract surgery. It is also a major theme of the Choosing Wisely campaign from the American Board of Internal Medicine.

Lee A. Fleisher, MD, chair of the department of Anesthesiology and Critical Care in the Perelman School of Medicine at the University of Pennsylvania authored a commentary alongside a study from a team from the University of Washington, Seattle, showing that, despite this evidence showing no benefit for patients, the incidence of preoperative tests is actually increasing for Medicare patients undergoing cataract surgery. The piece is published online today in the new issue of JAMA Internal Medicine.

Cataract surgery is unique among surgical procedures in that it has sufficient data to show that routine preoperative lab testing is not associated with improvement in outcomes when compared with patients who did not receive routine testing.

The ideal scenario, says Fleisher, is better communication between the anesthesiologist, when involved, surgeon, internist and other primary care provider in defining the population in need of preoperative testing to avoid unnecessary, high-cost, low-value care.

Dr. Fleisher suggests that payment reform may ultimately lead to more appropriate use of consultation and testing and that it "will be important for physicians, armed with this information about current practice patterns, to take the lead in choosing wisely with respect to which patients require a consultation and test before external forces do it for us."
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Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $4.3 billion enterprise.

The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 16 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $398 million awarded in the 2012 fiscal year.

The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania -- recognized as one of the nation's top "Honor Roll" hospitals by U.S. News & World Report; Penn Presbyterian Medical Center; Chester County Hospital; Penn Wissahickon Hospice; and Pennsylvania Hospital -- the nation's first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Chestnut Hill Hospital and Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine.

Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2012, Penn Medicine provided $827 million to benefit our community.

University of Pennsylvania School of Medicine

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