The impact of preoperative evaluation on perioperative events in patients undergoing cataract surgery: a cohort study
The impact of preoperative evaluation on perioperative events in patients undergoing cataract surgery: a cohort study
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DOI：
10.1038/eye.2016.203
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发表时间：
2016-12-01
期刊：
影响因子：
3.9
通讯作者：
Biolo, A.
中科院分区：
文献类型：
--
作者：
Alboim, C.;Kliemann, R. B.;Biolo, A.
目的门诊手术是外科和麻醉实践的一个主要领域，术前诊所越来越多地用于低风险的外科手术。本研究探讨了术前评估的影响围手术期事件的患者接受白内障surgery.Methods这是一项回顾性队列研究的968例连续接受白内障手术。从医疗记录中收集医疗条件、手术、麻醉和术后信息的详细信息。结果968例患者中，240例（24.7%）接受了门诊术前评估。无围手术期主要心血管事件。319例（33%）患者发生高血压，占所有不良事件的79.7%。术前评估显示，调整倾向评分后，高血压发生率较低（OR = 0.6; 95% CI 0.41-0.93）;未观察到对后囊破裂和术后7天内急诊/住院的影响。89例患者（9.3%）的初始收缩压≥ 180 mm Hg，这与后囊膜破裂（P = 0.158）或术后不良事件（P = 0.902）的风险无关。接受评估和未接受评估的患者的手术等待时间中位数分别为6个月和2个月（P < 0.001）。结论在低风险手术和无重大围手术期和术后结局的背景下，门诊术前评估似乎在减少白内障手术候选人的不良事件方面没有作用。尽管在评价的患者中观察到较少的高血压发作，但这些发作与任何医疗或手术结局无关。
Purpose Ambulatory surgery is a major area of surgical and anesthetic practice, and preoperative clinics are being increasingly used for low-risk surgical procedures. This study investigated the impact of preoperative evaluation on perioperative events in patients undergoing cataract surgery.Methods This was a retrospective cohort study of 968 consecutive patients undergoing cataract surgery. Details of medical conditions, surgical, anesthetic, and postoperative information were collected from medical records. A logistic regression model was developed using propensity score adjustment for baseline characteristics.Results Out 968 patients included, 240 (24.7%) underwent outpatient preoperative evaluation. There were no perioperative major cardiovascular events. Hypertension occurred in 319 (33%) patients, accounting for 79.7% of all adverse events. Preoperative evaluation resulted in a lower hypertension rate after adjustment for propensity score (OR = 0.6; 95% CI 0.41-0.93); no effects were observed on posterior capsule rupture and emergency visits/hospitalization within 7 days of surgery. Eighty-nine patients (9.3%) had an initial systolic pressure >= 180mm Hg, which was not associated with higher risk of posterior capsule rupture (P = 0.158) or postoperative adverse events (P = 0.902). Median waiting time to surgery was 6 and 2 months for evaluated and non-evaluated patients, respectively (P < 0.001).Conclusions In the context of low-risk surgery and no major perioperative and postoperative outcomes, it appears that outpatient preoperative evaluation has no role in reducing adverse events in cataract surgery candidates. Despite fewer hypertensive episodes observed in evaluated patients, these episodes were not associated with any medical or surgical outcomes.