PHILADELPHIA — 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.”
Penn Medicine is one of the world’s leading academic medical centers, dedicated to the related missions of medical education, biomedical research, excellence in patient care, and community service. The organization consists of the University of Pennsylvania Health System and Penn’s Raymond and Ruth Perelman School of Medicine, founded in 1765 as the nation’s first medical school.
The Perelman School of Medicine is consistently among the nation's top recipients of funding from the National Institutes of Health, with $550 million awarded in the 2022 fiscal year. Home to a proud history of “firsts” in medicine, Penn Medicine teams have pioneered discoveries and innovations that have shaped modern medicine, including recent breakthroughs such as CAR T cell therapy for cancer and the mRNA technology used in COVID-19 vaccines.
The University of Pennsylvania Health System’s patient care facilities stretch from the Susquehanna River in Pennsylvania to the New Jersey shore. These include the Hospital of the University of Pennsylvania, Penn Presbyterian Medical Center, Chester County Hospital, Lancaster General Health, Penn Medicine Princeton Health, and Pennsylvania Hospital—the nation’s first hospital, founded in 1751. Additional facilities and enterprises include Good Shepherd Penn Partners, Penn Medicine at Home, Lancaster Behavioral Health Hospital, and Princeton House Behavioral Health, among others.
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