Abstract
Purpose
Ambulatory surgery is a major area of surgical and anesthetic practice, and preoperative clinics are being increasingly used for low-risk surgical procedures. This study investigated the impact of preoperative evaluation on perioperative events in patients undergoing cataract surgery.
Methods
This was a retrospective cohort study of 968 consecutive patients undergoing cataract surgery. Details of medical conditions, surgical, anesthetic, and postoperative information were collected from medical records. A logistic regression model was developed using propensity score adjustment for baseline characteristics.
Results
Out 968 patients included, 240 (24.7%) underwent outpatient preoperative evaluation. There were no perioperative major cardiovascular events. Hypertension occurred in 319 (33%) patients, accounting for 79.7% of all adverse events. Preoperative evaluation resulted in a lower hypertension rate after adjustment for propensity score (OR=0.6; 95% CI 0.41–0.93); no effects were observed on posterior capsule rupture and emergency visits/hospitalization within 7 days of surgery. Eighty-nine patients (9.3%) had an initial systolic pressure ≥180 mm Hg, which was not associated with higher risk of posterior capsule rupture (P=0.158) or postoperative adverse events (P=0.902). Median waiting time to surgery was 6 and 2 months for evaluated and non-evaluated patients, respectively (P<0.001).
Conclusions
In the context of low-risk surgery and no major perioperative and postoperative outcomes, it appears that outpatient preoperative evaluation has no role in reducing adverse events in cataract surgery candidates. Despite fewer hypertensive episodes observed in evaluated patients, these episodes were not associated with any medical or surgical outcomes.
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Acknowledgements
We thank the translation agency Scientific Linguagem for assistance with the English-language presentation of the manuscript. The authors have no financial relationships relevant to this article to disclose.
Author contributions
CA: study concept and design, conduction of the study project, execution and coordination of data collection, statistical analysis, and drafting of the article; final approval of the article. RBK: study concept and design, data collection and insertion into database; drafting of the article, final approval of the article. LES: study concept and design, data collection and insertion into database; drafting of the article, final approval of the article. MMF: study concept and design, data collection and insertion into database; drafting of the article, final approval of the article. CAP: conduction of the study project, statistical analysis, and drafting of the article; final approval of the article. AB: study concept and design, study advisor, statistical analysis, drafting and review of the article; final approval of the article.
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Alboim, C., Kliemann, R., Soares, L. et al. The impact of preoperative evaluation on perioperative events in patients undergoing cataract surgery: a cohort study. Eye 30, 1614–1622 (2016). https://doi.org/10.1038/eye.2016.203
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DOI: https://doi.org/10.1038/eye.2016.203
