The value of routine preoperative medical testing before cataract surgery
The value of routine preoperative medical testing before cataract surgery
复制标题
DOI：
10.1056/nejm200001203420304
复制
发表时间：
2000-01-20
影响因子：
158.5
通讯作者：
Steinberg, EP
中科院分区：
文献类型：
--
作者：
Schein, OD;Katz, J;Steinberg, EP
背景常规的术前医学检查通常在计划接受白内障手术的患者中进行，尽管这种检查的价值尚不确定。我们进行了一项研究，以确定常规检查是否有助于减少术中和术后医疗并发症的发生率。方法我们随机分配了9个中心的18,189名患者的19557例择期白内障手术，除病史和体检外，在手术前或手术前不进行标准的医疗检查(心电图、全血计数和血清电解质、尿素氮、肌酐和葡萄糖水平的测量)。结果9408例患者接受了9626例未做常规检查的白内障手术，9411例接受了9624例手术前的常规检查，对医疗效果进行了评估。两组中最常见的医疗事件是高血压和心律失常(主要是心动过缓)的治疗。两组的总体并发症发生率(术中和术后事件合计)相同(每1000例手术中有31.3例并发症)。在术中事件发生率(分别为19.2和19.7)和术后事件发生率(12.6和12.1)方面，无试验组和试验组之间差异无统计学意义。根据年龄、性别、种族、身体状况(根据美国麻醉学家协会分类)和病史分层的分析显示，常规检查没有好处。结论白内障手术前的常规医学检查不能显著增加手术的安全性。(N Engl J Med 2000；342：168-75)(C)2000年，马萨诸塞州医学会。
Background Routine preoperative medical testing is commonly performed in patients scheduled to undergo cataract surgery, although the value of such testing is uncertain. We performed a study to determine whether routine testing helps reduce the incidence of intraoperative and postoperative medical complications.Methods We randomly assigned 19,557 elective cataract operations in 18,189 patients at nine centers to be preceded or not preceded by a standard battery of medical tests (electrocardiography, complete blood count, and measurement of serum levels of electrolytes, urea nitrogen, creatinine, and glucose), in addition to a history taking and physical examination. Adverse medical events and interventions on the day of surgery and during the seven days after surgery were recorded.Results Medical outcomes were assessed in 9408 patients who underwent 9626 cataract operations that were not preceded by routine testing and in 9411 patients who underwent 9624 operations that were preceded by routine testing. The most frequent medical events in both groups were treatment for hypertension and arrhythmia (principally bradycardia). The overall rate of complications (intraoperative and postoperative events combined) was the same in the two groups (31.3 events per 1000 operations). There were also no significant differences between the no-testing group and the testing group in the rates of intraoperative events (19.2 and 19.7, respectively, per 1000 operations) and postoperative events (12.6 and 12.1 per 1000 operations). Analyses stratified according to age, sex, race, physical status (according to the American Society of Anesthesiologists classification), and medical history revealed no benefit of routine testing.Conclusions Routine medical testing before cataract surgery does not measurably increase the safety of the surgery. (N Engl J Med 2000;342:168-75.) (C) 2000, Massachusetts Medical Society.