Do ophthalmologists, anesthesiologists, and internists agree about preoperative testing in healthy patients undergoing cataract surgery?
E. B. Bass, E. P. Steinberg, R. Luthra, O. D. Schein, J. M. Tielsch, J. C. Javitt, P. D. Sharkey, B. G. Petty, M. A. Feldman and D. M. Steinwachs
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
To assess variation in reported use of preoperative medical tests in
patients undergoing cataract surgery and to identify factors that influence
test use by different physician groups we performed a national survey of
ophthalmologists, anesthesiologists, and internists. Participants included
randomly selected members of American professional societies who provided
care to one or more patients undergoing cataract surgery in 1991. Responses
were obtained from 538 (82%) of 655 eligible ophthalmologists, 109 (76%) of
143 anesthesiologists, and 54 (44%) of 122 internists. Fifty percent of
ophthalmologists, 40% of internists, and 33% of anesthesiologists
frequently or always obtained a chest x-ray film, while 20% of
ophthalmologists, 27% of internists, and 37% of anesthesiologists never
obtained a chest x-ray film for patients being considered for cataract
surgery who had no history of major medical problems (P < .01 for
differences between ophthalmologists and the other groups). Similarly, 70%
to 90% of ophthalmologists, 73% to 79% of internists, and 41% to 79% of
anesthesiologists frequently or always obtained a complete blood cell
count, electrolyte panel, and electrocardiogram, while 4% to 11% of
ophthalmologists, 13% to 17% of internists, and 9% to 28% of
anesthesiologists never obtained these tests for such patients. Many
respondents (32% to 80%) believed tests were unnecessary but cited multiple
reasons for obtaining tests (eg, medicolegal concerns and institutional
requirements). Many physicians in each group viewed preoperative
evaluations as screening opportunities or believed that one of the other
two types of physicians "required" tests. We conclude that marked variation
exists within and across physician specialties in the use and rationale for
use of medical tests in patients undergoing cataract surgery.
