Evidence map›Paper›PMID 32926912›Full record

ArticleOphthalmology2021

Preoperative Medical Testing and Falls in Medicare Beneficiaries Awaiting Cataract Surgery.

Catherine L Chen, Stephen D McLeod, Thomas M Lietman, Hui Shen, W John Boscardin, Han-Ying Peggy Chang, Mary A Whooley, Adrian W Gelb, Sei J Lee, R Adams Dudley

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Ophthalmology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed
1.9field-weighted citation impact, top 12% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 20 citations in OpenAlex.

  1. Observational
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  8. Review
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors at 4 institutions in 1 country.

Catherine L ChenPhilip R. Lee Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, San Francisco, California; Center for Healthcare Value, University of California, San Francisco, San Francisco, California; Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California. Electronic address: catherine.chen@ucsf.edu.
Stephen D McLeodDepartment of Ophthalmology, University of California, San Francisco, San Francisco, California; The Francis I. Proctor Foundation for Research in Ophthalmology, Department of Ophthalmology, University of California, San Francisco, San Francisco, California.
Thomas M LietmanDepartment of Ophthalmology, University of California, San Francisco, San Francisco, California; The Francis I. Proctor Foundation for Research in Ophthalmology, Department of Ophthalmology, University of California, San Francisco, San Francisco, California.
Hui ShenSan Francisco VA Medical Center, San Francisco, San Francisco, California; Center for Healthcare Improvement and Medical Effectiveness, San Francisco VA Medical Center, and University of California, San Francisco, San Francisco, California.
W John BoscardinDepartment of Medicine, University of California, San Francisco, San Francisco, California; Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, California.
Han-Ying Peggy ChangMassachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
Mary A WhooleySan Francisco VA Medical Center, San Francisco, San Francisco, California; Center for Healthcare Improvement and Medical Effectiveness, San Francisco VA Medical Center, and University of California, San Francisco, San Francisco, California; Department of Medicine, University of California, San Francisco, San Francisco, California; Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, California.
Adrian W GelbDepartment of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California.
Sei J LeeSan Francisco VA Medical Center, San Francisco, San Francisco, California; Department of Medicine, University of California, San Francisco, San Francisco, California.
R Adams DudleyDepartment of Medicine, Informatics, and Health Policy & Management, Schools of Medicine and Public Health and Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota; Minneapolis VA Medical Center, Minneapolis, Minnesota.
University of California, San Francisco · USSan Francisco VA Medical Center · USMassachusetts Eye and Ear Infirmary · USUniversity of Minnesota · US

Funding

Comprehensive Anesthesia Research TrainingT32GM008440 · NIGMS · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI Judith Hellman · 1996 to 2026
$5.5M
Mentoring Patient-Oriented Research to Individualize Care for Hospitalized Older Adults with and without Alzheimer's Disease and Related DementiasK24AG066998 · NIA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI Sei Lee · 2021 to 2026
$1.1M
Improving Analysis of Endogenous Multimodal Treatments for Use in Geriatrics Health Outcomes StudiesI01HX002237 · VA · VA BOSTON HEALTH CARE SYSTEM · PI GARRIDO, MELISSA M · 2018 to 2021
–
HSRD VA SDR 02-237NIA NIH HHS K24 AG066998NIGMS NIH HHS T32 GM008440
6 · The paper itself

Abstract

purposeDelaying cataract surgery is associated with an increased risk of falls, but whether routine preoperative testing delays cataract surgery long enough to cause clinical harm is unknown. We sought to determine whether the use of routine preoperative testing leads to harm in the form of delayed surgery and falls in Medicare beneficiaries awaiting cataract surgery.

designRetrospective, observational cohort study using 2006-2014 Medicare claims.

participantsMedicare beneficiaries 66+ years of age with a Current Procedural Terminology claim for ocular biometry.

methodsWe measured the mean and median number of days between biometry and cataract surgery, calculated the proportion of patients waiting ≥ 30 days or ≥ 90 days for surgery, and determined the odds of sustaining a fall within 90 days of biometry among patients of high-testing physicians (testing performed in ≥ 75% of their patients) compared with patients of low-testing physicians. We also estimated the number of days of delay attributable to high-testing physicians.

main outcome measuresIncidence of falls occurring between biometry and surgery, odds of falling within 90 days of biometry, and estimated delay associated with physician testing behavior.

resultsOf 248 345 beneficiaries, 16.4% were patients of high-testing physicians. More patients of high-testing physicians waited ≥ 30 days and ≥ 90 days to undergo surgery (31.4% and 8.2% vs. 25.0% and 5.5%, respectively; P < 0.0001 for both). Falls before surgery in patients of high-testing physicians increased by 43% within the 90 days after ocular biometry (1.0% vs. 0.7%; P < 0.0001). The adjusted odds ratio of falling within 90 days of biometry in patients of high-testing physicians versus low-testing physicians was 1.10 (95% confidence interval [CI], 1.03-1.19; P = 0.008). After adjusting for surgical wait time, the odds ratio decreased to 1.07 (95% CI, 1.00-1.15; P = 0.06). The delay associated with having a high-testing physician was approximately 8 days (estimate, 7.97 days; 95% CI, 6.40-9.55 days; P < 0.0001). Other factors associated with delayed surgery included patient race (non-White), Northeast region, ophthalmologist ≤ 40 years of age, and low surgical volume.

conclusionsOveruse of routine preoperative medical testing by high-testing physicians is associated with delayed surgery and increased falls in cataract patients awaiting surgery.

Indexed as

Cataract ExtractionAccidental FallsAgedAged, 80 and overBiometryDiagnostic Tests, RoutineFemaleHumansIncidenceMaleMedicareOdds RatioPreoperative CareRetrospective StudiesTime-to-TreatmentUnited StatesCataractCataract surgeryDelayed surgeryFallFall-related injuryMedicare beneficiariesOcular biometryPhysician preoperative testing behaviorRoutine preoperative medical testingSurgical timing

Identifiers

PMID32926912
PMCPMC8443237
OpenAlexW3086944106

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.