Ophthalmology · 2025
Preoperative Screening Questionnaire for Common Eye Surgeries Safely Reduces the Need for Comprehensive History and Physical Examination.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Agrawal Anshuman, Joshi Preeti, Shah Rahul, Warner Nicole, Woreta Fasika A, Schein Oliver D
Аннотация
PURPOSE: To evaluate the safety and usefulness of a brief preoperative patient questionnaire (PQ) in reducing the need for a comprehensive history and physical (H&P) examination in patients undergoing cataract and similar eye surgeries.
DESIGN: Observational cohort study.
PARTICIPANTS: All patients (n = 7352) scheduled for anterior segment surgeries (n = 11 469) at an ambulatory surgical center from June 1, 2021, through December 31, 2024.
METHODS: The PQ was administered by scheduling staff, initially to a pilot cohort and then systematically to stratify patients based on medical risk. Patients with negative responses to all the questions (the PQ pass group) bypassed the H&P examination and reported to the hospital directly on the day of surgery, whereas others (the PQ fail group and the PQ not administered group) obtained a preoperative H&P examination within 60 days of the surgery. Patient demographics, scheduling details, PQ outcomes, day-of-surgery cancellations, and emergency department (ED) transfers were recorded. Analyses were performed using cluster-adjusted linear regression, logistic regression via generalized estimating equations with clustering by patient, and bootstrapped quantile (median) regression.
MAIN OUTCOME MEASURES: Rates of day-of-surgery cancellations for medical reasons, ED transfers, and the time from case creation to the date of surgery.
RESULTS: The PQ was administered for 4418 surgeries (2881 patients), with 81% passing it and bypassing a preoperative H&P. The cancellation rate for medical reasons was lower in the PQ pass group (0.6%) compared with the PQ not administered group (1.7%; P < 0.001) and the PQ fail group (1.4%; P = 0.07). Emergency department transfer rates were almost nonexistent and similar across groups. Compared with the PQ fail group, the PQ pass group showed a shorter time to surgery (14 days; P < 0.001). Multivariable analysis identified older age, Black race, American Society of Anesthesiologists Physical Status Class III or IV disease, and noncataract surgeries as factors associated with failing the PQ.
CONCLUSIONS: Most patients undergoing outpatient eye surgery can bypass a comprehensive preoperative H&P examination safely and can be identified using a questionnaire. This approach is safe, has low day-of-surgery cancellation rates, has quicker time to surgery, and substantially reduces patient, staff, and payor burden.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
DESIGN: Observational cohort study.
PARTICIPANTS: All patients (n = 7352) scheduled for anterior segment surgeries (n = 11 469) at an ambulatory surgical center from June 1, 2021, through December 31, 2024.
METHODS: The PQ was administered by scheduling staff, initially to a pilot cohort and then systematically to stratify patients based on medical risk. Patients with negative responses to all the questions (the PQ pass group) bypassed the H&P examination and reported to the hospital directly on the day of surgery, whereas others (the PQ fail group and the PQ not administered group) obtained a preoperative H&P examination within 60 days of the surgery. Patient demographics, scheduling details, PQ outcomes, day-of-surgery cancellations, and emergency department (ED) transfers were recorded. Analyses were performed using cluster-adjusted linear regression, logistic regression via generalized estimating equations with clustering by patient, and bootstrapped quantile (median) regression.
MAIN OUTCOME MEASURES: Rates of day-of-surgery cancellations for medical reasons, ED transfers, and the time from case creation to the date of surgery.
RESULTS: The PQ was administered for 4418 surgeries (2881 patients), with 81% passing it and bypassing a preoperative H&P. The cancellation rate for medical reasons was lower in the PQ pass group (0.6%) compared with the PQ not administered group (1.7%; P < 0.001) and the PQ fail group (1.4%; P = 0.07). Emergency department transfer rates were almost nonexistent and similar across groups. Compared with the PQ fail group, the PQ pass group showed a shorter time to surgery (14 days; P < 0.001). Multivariable analysis identified older age, Black race, American Society of Anesthesiologists Physical Status Class III or IV disease, and noncataract surgeries as factors associated with failing the PQ.
CONCLUSIONS: Most patients undergoing outpatient eye surgery can bypass a comprehensive preoperative H&P examination safely and can be identified using a questionnaire. This approach is safe, has low day-of-surgery cancellation rates, has quicker time to surgery, and substantially reduces patient, staff, and payor burden.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.