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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© Medical Xpress 2011-2013, Science X network
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."
Explore further: Pre-op depression linked to narcotic use before spinal Sx
Medical Xpress on facebook
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Pre-op depression linked to narcotic use before spinal Sx
Dec 19, 2013
(HealthDay)—For patients undergoing spinal surgery for a structural lesion, preoperative depression and anxiety are associated with increased preoperative narcotic use, according to a study published in ...
Researchers evaluate outcomes and costs in perioperative care
Aug 20, 2013
Differences in the utilization of intensive care services may be one potential explanation for improved outcomes after major surgery in the U.S. versus other nations, according to a commentary published in JAMA Surgery by res ...
List of five unnecessary vascular tests released
Feb 26, 2013
(HealthDay)—The Society for Vascular Medicine (SVM) has published "Five Things Physicians and Patients Should Question" in vascular medicine, a list of five tests and procedures that are commonly used but ...
Antibiotics before heart surgery protect against infection
5 hours ago
A new study found preoperative antibiotic therapy administered within two hours of cardiac surgery decreased the risk of developing surgical site infections (SSIs) significantly. The study was published in the January issue ...
SGO issues top five Choosing Wisely recommendations
Nov 06, 2013
(HealthDay)—The top five gynecologic oncology-related issues that physicians and patients should question have been released by the Society of Gynecologic Oncology (SGO) as part of the Choosing Wisely campai ...
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Dec 20, 2013
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Dec 19, 2013
Almost 8 percent of all implants used in hip replacement surgery have no readily available evidence relating to their safety or effectiveness, finds a study published in BMJ today.
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Dec 19, 2013
(HealthDay)—For patients undergoing spinal surgery for a structural lesion, preoperative depression and anxiety are associated with increased preoperative narcotic use, according to a study published in ...
Old-age specialists may boost recovery among injured seniors
Dec 19, 2013
(HealthDay)—Seniors who suffer an injury are more likely to regain their independence if they consult a geriatric specialist during their hospital stay, researchers report.
With sinus study, researchers find that harmless members of microbiome spark immune reaction
Dec 19, 2013
Saint Louis University researchers have analyzed the microbiomes of people with chronic rhinosinusitis and healthy volunteers and found evidence that some chronic sinus issues may be the result of inflammation triggered by ...
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Dec 19, 2013
The rigidity of current surgical instruments means it is sometimes only possible to remove part of a brain tumour. Limitations such as these led Professor Paul Breedveld to develop a fundamentally new class ...
User comments
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