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Cataract surgery is the most common elective surgery among Medicare beneficiaries, with 1.7 million procedures performed annually.1 It is also very safe, with less than a 1% risk of major adverse cardiac events or death.2 The mean duration of cataract surgery is 18 minutes,3 and virtually all surgical procedures are performed in an ambulatory setting with topical anesthesia.4 However, because patients are typically elderly with multiple coexisting conditions,5,6 physicians frequently order routine preoperative tests because of concerns about patient safety, worries about medicolegal risks, and the perception that other physicians expect preoperative testing.6,7
Despite these common justifications, previous studies have shown that routine preoperative medical testing neither decreases the incidence of adverse events nor improves the outcomes of cataract surgery.5,8–10 Therefore, since 2002, guidelines from multiple specialty societies have deemed routine preoperative testing unnecessary.2,11–15 When there is concern about a patient’s ability to undergo this low-risk surgery, these guidelines recommend a preoperative office visit and examination, with testing as indicated on the basis of the patient’s medical history and physical findings.2,11–15
Historically, preoperative testing was common: a 1993 study, performed before the current guidelines were issued, showed that about half of Medicare beneficiaries had at least one test or office visit within 30 days before cataract surgery.16 In addition, a more recent study showed that the prevalence of preoperative consultations for patients undergoing cataract surgery has been increasing since 199617; however, this research did not address whether preoperative testing has declined with the rising prevalence of preoperative office visits or whether preoperative testing varies among physicians. To assess more recent provider adherence to the guidelines, we analyzed Medicare claims for cataract surgery in 2011 to determine the prevalence of preoperative testing, the associated costs, the predictors of testing, and the extent of provider-level variation in ordering tests.
Methods
Study Oversight and Data Source
This study was approved by the institutional review board at the University of California, San Francisco. We obtained research identifiable files from the Centers for Medicare and Medicaid Services (CMS) Research Data Distribution Center for Medicare beneficiaries who underwent cataract surgery in 2011. For...