Evaluation of choosing wisely recommendations on preprocedural cardiovascular testing

Area of Science:

• Ophthalmology
• Cardiology
• Health Services Research

Background:

• The Choosing Wisely initiative recommends avoiding preprocedural testing in asymptomatic patients before low-risk surgery.
• Cataract surgery is a common, low-risk surgical procedure where preprocedural testing is often considered.

Purpose of the Study:

• To evaluate the impact of Choosing Wisely recommendations on preprocedural testing for cataract surgery.
• To assess the prevalence and justification of preprocedural testing in patients undergoing cataract surgery.

Main Methods:

• Retrospective cohort study at a single academic medical center.
• Analysis of 909 patients undergoing cataract surgery between January 2018 and December 2018.
• Comparison of preprocedural testing rates based on cardiac risk stratification using the Revised Cardiac Risk Index (RCRI).

Main Results:

• Only 9.9% of patients had preprocedural testing, with higher rates in elevated cardiac risk patients (15.9%) versus low-risk patients (6.7%).
• Electrocardiograms (ECGs) constituted the majority of tests ordered; abnormal results were infrequent (9 out of 90 tests).
• Anesthesiology clinicians ordered 95.6% of tests, often citing "routine" as justification, irrespective of cardiac risk.

Conclusions:

• Preprocedural cardiovascular testing for cataract surgery is not highly prevalent, rarely yields abnormal results, and is frequently not well-justified.
• Cataract surgery demonstrates exceptionally low rates of postprocedural cardiovascular events.
• Findings support revising Choosing Wisely recommendations to address prevalent areas of low-value care in preprocedural testing.