Are routine preoperative medical tests needed with cataract surgery?

OBJECTIVE: The objective of this study was to investigate whether routine medical testing before cataract surgery reduces the rate of complications during the perioperative period in adults. METHODS: The study was carried out in an academic medical center in Brazil, between 10 February 2000 and 10 January 2001. The scheduled cataract operations were randomly assigned to one of two groups: 1) to be preceded by routine testing (the "routine-testing group") or 2) not to be preceded by routine medical testing (the "selective-testing group"). If the patient was assigned to the selective-testing group, it was requested that no preoperative testing be performed unless the patient presented with a new or worsening medical problem that would warrant medical evaluation with testing. In the case of patients assigned to the routine-testing group, three tests were requested: a 12-lead electrocardiogram, a complete blood count, and measurements of serum glucose. RESULTS: The sample of 1,025 patients scheduled to undergo cataract surgery was comprised of 512 assigned to the routine-testing group and of 513 assigned to the selective-testing group. The two groups had similar proportions of operations canceled and not subsequently rescheduled, 2% in each group. The cumulative rate of medical events was similar in the two groups, 9.6% in the routine-testing group and 9.7% in the selective-testing group (P = 0.923). The types of medical events were also similar in both groups. DISCUSSION: The results of this study suggest that routine medical testing before cataract surgery does not reduce the rate of complications during the perioperative period. The results also suggest it would be more efficient not to request routine preoperative tests unless indicated by patient history or physical examination.     

Critical assessment of routine preoperative investigations.

The use of routine investigations is widespread in medical practice, particularly for preoperative assessment. Recent studies showed that some routine preoperative investigations are uninformative when ordered without a clinical indication. The rationale for preoperative investigations includes emphasis on history taking and clinical examination, as well as specific targets correlated to the surgical situation. Investigations could fall into three broad categories: discretionary tests which complete clinical history, baseline tests for interpretation of anticipated perioperative disturbances and screening tests for conditions affecting perioperative morbidity and mortality. Each investigation should answer a specific question and the result should influence decision-making. Application of these principles should lead to elimination of unnecessary tests and better utilization of medical information but further studies are needed for evaluation of such strategies.     

Guidelines for preoperative assessment: impact on clinical practice and costs.

OBJECTIVE: To describe preoperative evaluation in the San Giovanni Battista Hospital in Turin and to forecast the economic impact when preoperative assessment guidelines are implemented. DESIGN: We enrolled, in a month, 702 consecutive patients, excluding cardiac, thoracic, neuro- and vascular surgery, as well as emergency operations. Preoperative assessment data were collected individually, followed by simulating various applications of guidelines based on: (i) preoperative tests relying on full medical history and physical examination to discriminate preoperative risk patients; (ii) organization of a preoperative evaluation unit and tests before patient hospitalization. MAIN MEASURES: Mean number of tests prescribed, preoperative assessment cost per patient. RESULTS: The application of preoperative guidelines would decrease the mean number of tests prescribed from 20 laboratory and 1.9 instrumental to, respectively, 3 and 1.4 per patient. Tests deemed inappropriate by guidelines did not add any relevant clinical information to our study. Economic analysis estimates a reduction of 63% in cost per patient for preoperative tests by introducing guideline criteria (from 69 euros to 26 euros). As regards the cost per patient for preoperative evaluation and hospital stay (115 euros considering only variable costs, 580 euros including all costs), the application of the guidelines would reduce costs by 41-52% according to different cost evaluation approaches for hospital stay. CONCLUSION: Preoperative guidelines fully introduced in practice could notably increase efficiency without affecting the quality of care.     

Predictive value of preoperative tests in facectomy

OBJECTIVE: To establish the prevalence of abnormal results in routine preoperative tests prior to facectomies and whether they influence the occurrence of perioperative clinical complications. METHODS: This prospective study was developed in an academic medical center in Brazil. Besides a clinical evaluation, all patients were requested to undergo an electrocardiogram, complete blood work and fasting blood glucose test. Patients younger than 40 years of age who had had previous eye surgery, candidates for general anesthesia or who had suffered acute myocardial infarction up to three months before surgery were excluded from the study. Intraoperative medical events were recorded in a protocol form. Analysis was carried out using Fisher's test and ANOVA (analysis of variance). RESULTS: The sample was composed of 746 patients, 405 (54.3%) were men. The average age was 66.6+/-11.6 years. Intraoperative complications occurred in 71 (9.5%) patients. There were abnormal results in 13.5% (101 patients) of hemoglobin dosages and in 16.6% (124) of fasting blood glucose. As for electrocardiograms, abnormalities were found in 46.6% (348) of the subjects. There was a higher prevalence of electrocardiograms with abnormal values in patients who had perioperative clinical complications (p=0.02). There were no statistically significant differences between hemoglobin dosages (14.0+/-1.6 g/dL in patients without intraoperative complications and 14.3+/-1.3 g/dL in patients with complications - p=0.150) and fasting blood glucose (104+/-29 mg/dL in patients without complications and 105+/-41 mg/dL in patients with complications - p=0.850). CONCLUSIONS: Within the investigated routine of preoperative testing for facectomy, only the abnormal electrocardiogram results influenced the occurrence of complications in the perioperative period.     

Audit of cost and clinical outcome of cataract surgery

An audit of routine cataract surgery in our hospital was carried out by examining records of 340 adult patients who underwent such surgery during October 1990. The category of intended accommodation (day case or inpatient), operative details, post-operative course and management were recorded, along with the outcome measures of visual acuity (unaided and corrected) and refractive error (spherical equivalent and cylinder). The costs of treatment, including post-operative management, were calculated for each patient. The results indicate that day case surgery under local anaesthesia was the most cost-effective method of cataract surgery, with no detrimental effect on clinical outcome.     

临床护理路径对白内障手术患者术中应激反应及并发症的影响

目的探讨临床护理路径对白内障手术患者术中应激反应及并发症的影响。方法选择2017年6月至2019年6月我院收治的180例白内障手术患者,随机分为两组各90例。对照组施行常规护理模式,观察组施行临床护理路径模式,比较两组患者的术中应激反应及并发症。结果术前,两组的平均动脉压(MAP)、心率(HR)比较,差异无统计学意义(P>0.05);术中15 min、术后,观察组的MAP、HR均显著低于对照组(P<0.05)。观察组的术后并发症发生率显著低于对照组(P<0.05)。结论白内障手术患者采用临床护理路径模式具有明显的效果,可缓解术中不良应激反应,减少并发症的发生。     

护理临床路径在肠息肉内镜术中的临床价值分析

目的探讨护理临床路径在肠息肉内镜术中的临床价值。方法选取我院2012年5月至2014年4月间行肠息肉内镜术患者860例,随机分为观察组与对照组,每组430例。对照组患者给予常规护理,观察组患者给予护理临床路径。对两组术前天数、住院时间、住院费用以及满意度进行观察比较。结果观察组术前天数、住院时间以及住院费用均显著少于对照组(P<0.05),观察组满意度明显高于对照组(P<0.05)。结论肠息肉内镜术患者应用护理临床路径,住院时间短,费用低,患者满意度高,值得推广与使用。     

Survey of meticillin-resistant Staphylococcus aureus policies in UK eye departments

The purpose of this study was to investigate meticillin-resistant Staphylococcus aureus (MRSA) screening and decolonisation practices for patients undergoing routine cataract surgery in ophthalmology departments across the UK. A postal questionnaire survey of all ophthalmology departments in the UK was carried out, with 75 of 152 (49.3%) questionnaires returned. Sixty-three percent of units had a departmental MRSA policy. Preoperative MRSA screening was performed in 50 (66.7%) units, three of which screened all preoperative patients and the remainder performed selective screening. The proportion of patients screened for MRSA ranged from 0 to 100%, with a median of 2% and a mean of 9.9% (95% confidence interval: 3.5–16.2%). Overall, 65.3% of respondents felt that their departmental policy was reasonable, although there was considerable dissatisfaction and confusion, with comments identifying lack of evidence and the need for guidelines applicable to day-case cataract surgery. The survey demonstrates significant inconsistencies in preoperative MRSA screening practice in ophthalmology departments throughout the UK. Current recommendations from the Department of Health suggest that day-case ophthalmology patients do not require routine screening, although the implication appears that high risk patients continue to do so. Further investigation is required to ascertain the scientific validity of these recommendations.     

Patients' preoperative expectation and outcome of cataract surgery at jimma university specialized hospital -department of ophthalmology

Background

Patient''s satisfaction for a given treatment is an important clinical outcome because a satisfied patient is more likely to comply with treatments, attend follow-ups and advocate the service to others. Therefore, knowing patients'' expectations before a planned procedure or treatment and the actual level of satisfaction and fulfillment of their initial expectations thereafter is much helpful. As far as the knowledge and experience of the researchers is concerned, there has not been any study conducted in Ethiopia to find out about patients'' preoperative expectations and postoperative level of satisfaction for actual outcomes. This study was therefore, conducted to describe and find out the relationship between preoperative expectations of cataract patients and the actual postoperative experience and their satisfaction level following the surgery at ophthalmology department in Jimma University Specialized Hospital.

Methods

A prospective cohort study of patients undergoing first eye cataract surgery was conducted from July 10 to Oct., 10, 2007 in the Ophthalmology department of Jimma University Specialized Hospital. Detailed interviews that included general and vision specific health status measures and patients'' preoperative expectations for cataract surgery outcomes were performed followed by visual acuity testing. Postoperatively, visual acuity testing was taken again and patients'' level of satisfaction with attained postoperative vision was assessed. Data were collected and filled in a separate questionnaire form for each patient, and entered into a computer and analyzed using SPSS for Windows version 12.0.

Results

Of the 200 patients operated for cataract, 179 (89.5%) were followed for the whole five weeks. The average expected preoperative Visual Function-15 score was 96.3, compared to an achieved (postoperative) Visual Function-15 score of just 96.2. However, the most unrealistic expectations observed were reading small prints and doing fine handiwork. The final pinhole visual acuity postoperatively was ≤ 6/18 in 126 (70.4%) patients. Of the 78 (39%) patients who were bilaterally blind preoperatively, 5 (2.5%) patients remained blind postoperatively.

Conclusions

Significant improvements were obtained in clinical, functional, and perceived vision by cataract surgery involving extracapsular cataract extraction with posterior chamber intraocular lens implantations. Expectations regarding visual functioning after cataract surgery were very high, and in most cases and in most cases they were fulfilled.     

The unproven utility of the preoperative urinalysis: Economic evaluation

The clinical effectiveness of the preoperative urinalysis is unproven, yet it is routinely obtained before surgery. To determine if the routine urinalysis might be economically beneficial, we evaluated its cost-effectiveness and cost-benefit.

In the setting of elective clean-wound, non-prosthetic knee procedures, we estimated that: (1) nearly U.S. $7,000,000 is spent annually on preoperative urinalyses and associated costs; (2) given the best estimate of the increase in risk of wound infection attributable to urinary tract infection, 4.58 wound infections may be prevented annually, at a cost of $1,500,000 per wound infection prevented; (3) the cost of treating additional cases of wound infection, given no preoperative urinalysis, is approximately five hundred-fold less than the cost of screening with routine urinalyses.

We conclude that the routine preoperative urinalysis is clinically and economically unsound before clean-wound, non-prosthetic knee surgery and probably before other types of clean-wound surgery. For this relatively inexpensive test, aggregate costs are disproportionately high and appear to outweigh clinical benefits.     

舒适护理在子宫肌瘤手术患者临床护理路径中的效果观察

目的:探讨舒适护理在子宫肌瘤手术患者临床护理路径中的应用效果。方法:将200例子宫肌瘤需手术的患者随机分为对照组和实验组各100例,两组均进入临床护理路径,对照组实施临床护理路径的常规护理,实验组在临床护理路径的基础上实施舒适护理。结果:实验组患者的医疗质量明显提高,并发症发生率降低,术前焦虑、术后疼痛、环境、体位、心理等舒适度指标与对照组比较差异均有统计学意义(P<0.05)。结论:在应用临床护理路径的子宫肌瘤手术患者中实施舒适护理,不但可缩短平均住院时间、降低医疗成本和并发症发生,同时能提高护理服务质量,提升患者的舒适度和满意度,从而切实提高护理质量。     

Outcomes and costs of outpatient and inpatient cataract surgery: a randomised clinical trial

The aim of this study was to compare clinical and perceived health outcomes and cost between ambulatory and inpatient cataract surgery. An unmasked randomised clinical trial was undertaken. Cataract surgery patients of three public hospitals in Barcelona (Spain) who met inclusion criteria for ambulatory surgery were randomly assigned to two groups: outpatient hospital and inpatient hospital. Primary outcome measures were early and late postoperative surgical complications and visual acuity. Secondary outcome measures were perceived visual function, overall perceived health status, and costs. A total of 464 outpatients and 471 inpatients were analysed. No statistically significant differences were observed between the two groups in visual acuity (P =.48), nor for the other clinical and perceived health outcome measures, except for early postoperative complications. Outpatients presented at least one complication in the first 24 h after surgery more frequently than inpatients (64 vs. 43; RR 1.6, 95% CI 1.1, 2.4), but 4 months after surgery the differences in complications rates between groups disappeared. The cost of surgery was lower for outpatients than for inpatients (1001 vs. 1218 Euros; P <.001). Ambulatory cataract surgery was more cost-effective than inpatient surgery. Despite the higher risk of early complications in the outpatient hospital group, these differences may not be clinically relevant because the 4-month postoperative outcomes were not affected.     

Inappropriateness of cataract extraction: an analysis in two Israeli hospital settings.

OBJECTIVE: To assess and compare the appropriateness of cataract extraction in two Israeli regional hospitals. SETTINGS: Two Israeli hospitals located in different geographic areas. DESIGN: A randomized sample of 150 patients was drawn from a list of all patients who underwent cataract surgery at the two study hospitals during 1995. Detailed extraction of hospital medical records was performed. The appropriateness of cataract surgery was assessed using the Medical Review System, an interactive expert system that assesses the appropriateness of selected medical and surgical procedures. RESULTS: The rates of cataract surgery in the two hospitals were 0.54 and 0.59 operations per 1,000 population, respectively, and the age-adjusted rates per 1,000 population were 5.7 and 6.2, respectively. The percentage of patients with only light perception or hand-motion perception in the operated eye before the operation was 62.2%, with no difference in the two hospitals. There was not a significant difference in the distribution of visual acuity before the operation; however, there was a significant difference in the distribution of visual acuity after the surgery. Rates of inappropriate surgeries in the two hospitals were found to be similar to the inappropriate rate in the United States (1.3%). The preoperative visual acuity of patients undergoing cataract surgery in Israel was inferior to the visual acuity of patients undergoing cataract surgery in the United States. CONCLUSION: To increase quality and cost-effectiveness in the Israeli medical system, future studies of this type are warranted in connection with surgical procedures.     

治疗性沟通对白内障患者术前疾病不确定感的影响

目的探讨治疗性沟通对白内障患者术前疾病不确定感的影响。方法选取76例白内障择期手术患者按住院时间分为对照组和试验组,每组38例。对照组给予术前常规护理及一般性沟通,试验组在此基础上实施治疗性沟通,分别于干预前(入院当天)、干预后(手术前1天下午)采用疾病不确定感量表对两组患者进行测评。结果干预前,两组患者的疾病不确定感总分及各维度得分比较,差异无统计学意义(p>0.05)。干预后,试验组的疾病不确定感总分及各维度得分明显低于对照组同期得分(p<0.01或0.05)。结论治疗性沟通能有效降低白内障患者术前的疾病不确定感。     

In a randomized controlled trial, cataract surgery in both eyes increased benefits compared to surgery in one eye only

BACKGROUND AND OBJECTIVE: Despite recommendation of surgery in both eyes in patients with bilateral cataract, there is little evidence about the benefits of second-eye surgery. The objective of this study was to compare the benefits of cataract surgery in both eyes with those of surgery in one eye only. STUDY DESIGN AND SETTING: Two-arm randomized controlled trial involving 296 patients with bilateral cataracts of two public teaching hospitals. Patients were randomly assigned to receive surgery in one eye only (control group) or surgery in both eyes, one eye at a time (intervention group). The main outcome measures were binocular visual acuity, binocular contrast sensitivity, stereopsis, and patient-reported visual disability (VF-14), measured 4-6 months postoperatively. RESULTS: A total of 135 (91.2%) and 139 (93.9%) patients completed the trial in the control and intervention groups, respectively. Postoperatively, intervention group presented a better visual acuity (difference of 0.07; 95% CI = 0.03, 0.12), stereopsis (0.62 log sec arc; 95% CI = 0.45, 0.79), and VF-14 (8.2 points; 95% CI = 4.4, 12.4). No significant differences were found for contrast sensitivity. CONCLUSIONS: Bilateral cataract patients should have surgery in both eyes. Including stereopsis and patient-reported visual disability in the assessment of cataract patients, especially after first-eye surgery, will improve the evaluation of effectiveness.     

老年性白内障住院手术患者特征及费用影响因素分析

目的探讨老年性白内障住院手术患者的住院特征和住院费用影响因素,为规范诊疗流程和降低医疗费用提供参考。方法对患者人口学特征、住院信息等进行描述性分析,采用多重线性回归分析住院费用的影响因素。结果总费用中材料费占比例最高,不同医师经治患者的平均术前住院日、平均住院日、平均费用差异较大。住院天数、人工晶体价格是影响患者住院费用的主要因素。结论通过推行临床路径,规范诊疗流程,选择合理的植入晶体,是控制医疗费用的关键。     

人性化护理应用于多次胆道手术患者的临床效果

目的观察人性化护理应用于多次胆道手术患者的临床效果。方法收集笔者所在科2008年3月至2009年3月收治的多次胆道手术患者68例,随机分为观察组和对照组各34例。对照组采用常规护理方法,观察组采用人性化护理,比较分析两组的临床效果。结果观察组患者对护理人员的信任度及满意度均高于对照组（P〈0．05）。结论人性化护理应用于多次胆道手术患者的临床观察效果满意,值得推广应用。     

实施单病种质量控制的效果评价

目的:探讨单病种质量控制对医疗费用、住院天数的影响。方法:将2011年1季度未实施单病种质量控制的患者154例归为对照组,2012年1季度实施单病种质量控制的患者213例归到实验组,以医疗费用、住院天数、药品费用、检查费用等作为评价指标,应用SPSS 13.0进行统计分析。结果:剖宫产术实验组病人总费用较对照组有所升高,住院天数明显下降;脑梗塞实验组病人总费用较对照组明显升高;心力衰竭实验组病人总费用较对照组明显下降,差异均有统计学意义(P0.01或P0.05)。儿科肺炎、老年性白内障两组病人总费用的差异,以及儿科肺炎、脑梗塞、心力衰竭、老年性白内障住院天数的差异均无统计学意义(P0.05)。结论:实行单病种质量控制,能降低医疗费用及住院天数,提高医疗质量。     

综合护理干预预防白内障超声乳化术后干眼症发生效果观察

目的观察综合护理干预预防白内障超声乳化术后患者干眼症发生的效果。方法对2013年10月至2014年3月在我院行白内障超声乳化术的患者400例并随机分为两组,每组200例。对照组采取常规护理,干预组采取护理干预+常规护理;观察两组患者术后干眼症发生情况。结果干预组患者术后干眼症发生率显著低于对照组,差异有统计学意义(P<0.05);与对照组相比,干预组患者泪液分泌量多,角膜荧光染色评分低,而BUT评分高,差异有统计学意义(P<0.05)。结论综合护理干预不仅能有效预防白内障超声乳化术后患者干眼症的发生,而且有利于改善患者预后,对提高手术疗效具有重要意义。