Research Update
Eye-opening cataract study shows routine tests unnecessary
CMAJ 2000;162:1034
Blood counts, serum electrolyte measurements and electrocardiograms are routinely ordered for patients undergoing cataract surgery. Now new research from the US has found that these tests do not offer patients any medical benefit (N Engl J Med 2000; 342:168-75). "The study shows quite definitively that there is no role for routine medical testing for patients who are scheduled for routine cataract surgery," says lead investigator Dr. Oliver Schein, professor of ophthalmology at the Wilmer Eye Institute at the Johns Hopkins Medical Institute.
"Common practice is to simply say, 'OK, the patient is scheduled for surgery. The patient needs a history, physical and lab tests.' The history and the physical are still necessary but the lab tests offer no benefit," he notes.
Researchers at 9 medical centres throughout the US randomly assigned more than 19 000 patients scheduled for cataract surgery into 1 of 2 groups. One group received pre-operative testing and the other did not. All medical complications that occurred over the 7-day period following surgery were recorded.
No significant differences were found between the 2 groups in terms of events during or after the operation. For events during the operation, patients who underwent testing had 19.7 events per 1000 operations, compared with 19.2 for the group without testing. For events following the operation, the testing group had 12.1 events per 1000 operations while the no-testing group 12.6. Serious medical events were very rare in both groups, and the overall rate of complications was similar, at 31.3 events per 1000 operations. In addition, researchers found no benefit to testing when the results were analysed by the patients' age, sex, race or existing medical conditions.
"We recommend that tests be ordered only when the history or a finding on physical examination would have indicated the need for a test even if surgery had not been planned," Schein says.
The results, he adds, may apply to most routine surgery. "We only studied cataract surgery, but there have been a lot of smaller studies over the years that relate to other non-major surgeries that have looked at the benefit of testing. They virtually all say the same thing — there is no benefit to testing." — Donalee Moulton, Halifax
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