Preoperative Screening Questionnaire for Common Eye Surgeries Safely Reduces the Need for Comprehensive History and Physical Examination.

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.