Preoperative medical testing overuse delays surgery, ups falls in cataract patients

Overuse of routine preoperative medical testing by high-testing physicians results in delayed surgery and increased falls in patients awaiting cataract surgery, reveals a US study.

A total of 248,345 Medicare beneficiaries aged ≥66 years with a Current Procedural Terminology claim for ocular biometry were included in this retrospective, observational cohort study.

The authors measured the mean and median number of days between biometry and cataract surgery, calculated the proportion of patients waiting ≥30 or ≥90 days for surgery, and determined the odds of sustaining a fall within 90 days of biometry among patients of high-testing physicians (testing performed in ≥75 percent of their patients) compared with those of low-testing physicians. They also estimated the number of days of delay attributable to high-testing physicians.

Of the beneficiaries, 16.4 percent were patients of high-testing physicians. More patients of high- vs low-testing physicians waited ≥30 and ≥90 days to undergo surgery (31.4 percent and 8.2 percent vs 25.0 percent and 5.5 percent, respectively; p<0.0001 for both).

Falls prior to surgery in patients of high-testing physicians increased by 43 percent within the 90 days after ocular biometry (1.0 percent vs 0.7 percent; p<0.0001), with an odds ratio (OR) of 1.10 (95 percent confidence interval [CI], 1.03–1.19; p=0.008). The OR decreased to 1.07 (95 percent CI, 1.00–1.15; p=0.06) after adjusting for surgical wait time.

An 8-day delay was observed with having a high-testing physician (estimate, 7.97 days, 95 percent CI, 6.40–9.55; p<0.0001). Other factors associated with delayed surgery were patient race (non-white), Northeast region, ophthalmologist ≤40 years of age, and low surgical volume.

“Delaying cataract surgery is associated with an increased risk of falls,” the authors said.