Clinical Question

Does preoperative testing before cataract surgery lead to fewer perioperative adverse events?

Evidence-Based Answer

Routine preoperative testing before cataract surgery does not reduce intraoperative or postoperative complications. (Strength of Recommendation = A, based on consistent and good quality patient-oriented evidence).

Practice Pointers

Family physicians commonly provide preoperative examinations and medical clearance before major surgeries. Preoperative medical testing may include screening electrocardiography, chest radiography, complete blood counts, and serum measurements. For a minor surgery such as cataract surgery, it is unclear which specific laboratory or other tests are necessary.

The researchers in this Cochrane review identified three randomized controlled trials with a total of 21,868 patients. These studies examined rates of intraoperative and postoperative medical adverse events in patients who received routine preoperative medical testing compared with those who did not receive routine testing or those who received selective preoperative testing before cataract surgery. Pooled analysis of these three studies concluded that preoperative medical testing did not reduce the rate of intraoperative (odds ratio [OR] = 1.02; 95% confidence interval [CI], 0.85 to 1.22) or postoperative (OR = 0.96; 95% CI, 0.74 to 1.24) medical adverse events compared with selective or no testing. No significant differences were reported in the rate or types of intraoperative and postoperative ocular adverse events in the preoperative testing group compared with the selective or no testing groups. There were no differences in postoperative hospitalizations (OR = 0.83; 95% CI, 0.49 to 1.42) and deaths (OR = 0.50; 95% CI, 0.05 to 5.52). One study also examined testing costs, and it found that those who had routine preoperative medical testing incurred costs 2.5 times higher than the costs for those who had selective preoperative testing.

The American Academy of Ophthalmology recommends against routine medical tests before cataract surgery, although pre-operative medical tests can be ordered when indicated by findings on a patient's history or physical examination.¹ The American Heart Association recommends against the use of routine testing in asymptomatic patients undergoing low-risk procedures such as cataract surgery because the cardiac risk associated with low-risk procedures is generally less than 1 percent.²