Preoperative Medical Testing and Falls in Medicare Beneficiaries Awaiting Cataract Surgery

Catherine L. Chen, Stephen D. McLeod, Thomas M. Lietman, Hui Shen, W. John Boscardin, Han Ying Peggy Chang, Mary A. Whooley, Adrian W. Gelb, Sei J. Lee, R. Adams Dudley

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: Delaying cataract surgery is associated with an increased risk of falls, but whether routine preoperative testing delays cataract surgery long enough to cause clinical harm is unknown. We sought to determine whether the use of routine preoperative testing leads to harm in the form of delayed surgery and falls in Medicare beneficiaries awaiting cataract surgery. Design: Retrospective, observational cohort study using 2006–2014 Medicare claims. Participants: Medicare beneficiaries 66+ years of age with a Current Procedural Terminology claim for ocular biometry. Methods: We measured the mean and median number of days between biometry and cataract surgery, calculated the proportion of patients waiting ≥ 30 days or ≥ 90 days for surgery, and determined the odds of sustaining a fall within 90 days of biometry among patients of high-testing physicians (testing performed in ≥ 75% of their patients) compared with patients of low-testing physicians. We also estimated the number of days of delay attributable to high-testing physicians. Main Outcome Measures: Incidence of falls occurring between biometry and surgery, odds of falling within 90 days of biometry, and estimated delay associated with physician testing behavior. Results: Of 248 345 beneficiaries, 16.4% were patients of high-testing physicians. More patients of high-testing physicians waited ≥ 30 days and ≥ 90 days to undergo surgery (31.4% and 8.2% vs. 25.0% and 5.5%, respectively; P < 0.0001 for both). Falls before surgery in patients of high-testing physicians increased by 43% within the 90 days after ocular biometry (1.0% vs. 0.7%; P < 0.0001). The adjusted odds ratio of falling within 90 days of biometry in patients of high-testing physicians versus low-testing physicians was 1.10 (95% confidence interval [CI], 1.03–1.19; P = 0.008). After adjusting for surgical wait time, the odds ratio decreased to 1.07 (95% CI, 1.00–1.15; P = 0.06). The delay associated with having a high-testing physician was approximately 8 days (estimate, 7.97 days; 95% CI, 6.40–9.55 days; P < 0.0001). Other factors associated with delayed surgery included patient race (non-White), Northeast region, ophthalmologist ≤ 40 years of age, and low surgical volume. Conclusions: Overuse of routine preoperative medical testing by high-testing physicians is associated with delayed surgery and increased falls in cataract patients awaiting surgery.

Original languageEnglish (US)
JournalOphthalmology
DOIs
StateAccepted/In press - 2020

Bibliographical note

Funding Information:
Supported by the University of California , San Francisco, Anesthesia Research Support, San Francisco, California; the Foundation for Anesthesia Education and Research, Schaumburg, Illinois; the National Institutes of Health , Bethesda, Maryland (grant no.: T32 GM008440 , to the Department of Anesthesia and Perioperative Care, University of California , San Francisco); Research to Prevent Blindness , Inc, New York, New York (S.D.M.). The sponsors had no role in the design or conduct of the study; the collection, management, analysis and interpretation of the data; the preparation, review or approval of the manuscript; or the decision to submit the manuscript for publication. Support for Veterans Affairs/Centers for Medicare and Medicaid Services data provided by the Department of Veterans Affairs, VA Health Services Research and Development Service, VA Information Resource Center (grant nos.: SDR 02-237, 98-004).

Keywords

  • Cataract
  • Cataract surgery
  • Delayed surgery
  • Fall
  • Fall-related injury
  • Medicare beneficiaries
  • Ocular biometry
  • Physician preoperative testing behavior
  • Routine preoperative medical testing
  • Surgical timing

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