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Preoperative Screening Questionnaire for Common Eye Surgeries Safely Reduces the Need for Comprehensive History and
Anshuman Agrawal1, Preeti Joshi2, Rahul Shah1
1Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Ophthalmology
|July 10, 2025
Summary
A brief preoperative patient questionnaire (PQ) safely identifies most patients undergoing eye surgery who can bypass a full history and physical (H&P). This streamlines care, reduces cancellations, and speeds up surgery scheduling.
Area of Science:
- Ophthalmology
- Anesthesiology
- Health Services Research
Background:
- Comprehensive preoperative history and physical (H&P) examinations are standard for many surgical procedures.
- Evaluating the necessity of a full H&P for lower-risk outpatient surgeries can optimize resource allocation and patient flow.
- Cataract and similar anterior segment surgeries are frequently performed in ambulatory settings under monitored anesthesia care.
Purpose of the Study:
- To assess the safety and effectiveness of a brief preoperative patient questionnaire (PQ) in determining eligibility for bypassing a full H&P for eye surgeries.
- To evaluate the impact of using a PQ on surgical cancellations and time-to-surgery.
Main Methods:
- An observational cohort study involving 7352 patients undergoing 11469 anterior segment surgeries.
- A physician-developed PQ was administered to stratify patients by medical risk.
- Patients passing the PQ (PQ-pass) bypassed the H&P; others required a preoperative H&P.
- Outcomes included day-of-surgery cancellations, emergency department transfers, and time from case creation to surgery.
Main Results:
- 81% of patients who received the PQ passed and bypassed the H&P.
- The PQ-pass group had a significantly lower medical cancellation rate (0.6%) compared to PQ-fail (1.4%) and PQ-not-administered (1.7%) groups.
- The PQ-pass group experienced a significantly shorter time-to-surgery (14 days) compared to the PQ-fail group.
- Older age, Black race, higher ASA class, and non-cataract surgeries were associated with failing the PQ.
Conclusions:
- A brief PQ is a safe and effective tool for identifying patients who can safely forgo a comprehensive preoperative H&P for outpatient eye surgery.
- This streamlined approach reduces day-of-surgery cancellations and shortens the time to surgery.
- Implementing the PQ significantly reduces the burden on patients, staff, and payers.
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