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Preoperative Consultations for Medicare Patients Undergoing Cataract Surgery
Study Questions:
What are trends in and reasons for preoperative consultation in the US Medicare population before cataract surgery?
Methods:
This was a retrospective cohort study of US residents 66 years or older using a 5% national random sample of Medicare part B files for the years 1995 to 2006. The primary endpoint was the occurrence of preoperative or inpatient consultation within 42 days before the index surgery. Temporal trends in consultations were evaluated in the entire cohort (n = 556,637). Explanatory factors (for consultation) and geographic variation were evaluated within those patients who underwent surgery from 2005 to 2006 (n = 89,817).
Results:
From 1998 to 2006, the frequency of preoperative consultations increased from 11.3% to 18.4%, respectively. The following factors are associated with preoperative consultation: increased age, race, urban residence, facility type (outpatient hospital vs. ambulatory surgical facility), anesthesia provider, and geographic region (Northeast).
Conclusions:
The frequency of preoperative consultation among US Medicare beneficiaries increased from 1995 to 2006. Except for advancing age, nonmedical factors (e.g., hospital facility type, geographic region, etc.) were primarily predictive of preoperative consultation.
Perspective:
This is an important study that establishes there is substantial use of preoperative medical consultation for cataract surgery, a low-risk surgical procedure for which routine preoperative medical testing is rarely indicated. As the authors conclude, there is a need (and opportunity) for ‘interventions aimed at reducing unwanted practice variability.’ Such interventions have the potential to dramatically reduce potentially unnecessary and wasteful health care expenditures and help providers ‘choose wisely.’
Keywords: Medicare Part B, Cataract Extraction, Outpatients, Delivery of Health Care, Referral and Consultation, Health Expenditures, Cataract, Inpatients, United States
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