Routine history and physical examinations prior to cataract surgery are not beneficial

To determine the safety of a policy change eliminating the requirement for preoperative history and physical examination before cataract surgery.

A retrospective population-based study.

Because preoperative history and physical examination were no longer required in Alberta after April 1, 2017, a retrospective review of provincial health claims data was conducted to determine the safety of removing this requirement. Data from Albertans who underwent cataract surgery and had a preoperative medical examination between April 2014 and March 2017 were compared with data from those who underwent surgery between April 2017 and May 2020 without one. The primary outcome was adverse medical events, defined as an emergency room visit, inpatient admission, or death within 30 days of cataract surgery.

A total of 236,046 cataract surgeries were performed over the study period. The likelihood of a postoperative emergency room visit was higher (odds ratio [OR] = 1.04; 95% CI, 1.01-1.08) in the preoperative examination group (n = 112,806 eyes), occurring in 4.8% of patients, compared with 4.7% in the no preoperative examination group (n = 123,240 eyes; p = 0.03). Inpatient admissions also were more likely to occur in the preoperative examination group (OR = 1.26; 95% CI, 1.18-1.34) at 1.8% in comparison with 1.5% in the no preoperative examination group (p < 0.0001). The death rate in both groups was 0.09% (p = 0.992).

The rate of postoperative emergency room visits and inpatient admissions within 30 days of cataract surgery was negligibly different, indicating that preoperative examinations, which have been traditionally performed to reduce postoperative morbidity and mortality, offer little value to patients.