Preoperative medical testing and falls in Medicare beneficiaries awaiting cataract surgery.
Delaying cataract surgery is associated with an increased risk of falls, but it is unknown whether routine preoperative testing delays cataract surgery long enough to cause clinical harm. 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.Retrospective observational cohort study using 2006-2014 Medicare claims PARTICIPANTS: Medicare beneficiaries age 66+ with a CPT claim for ocular biometry METHODS: We measured the mean and median number of days between ocular biometry and cataract surgery, calculated the proportion of patients waiting >30 days or >90 days for surgery, and determined the odds of having a fall within 90 days of biometry among patients of high-testing physicians (testing performed in ≥75% of their patients) compared to patients of low-testing physicians. We estimated the number of days of delay attributable to high-testing physicians relative to other factors that may determine surgical scheduling.Incidence of falls occurring between biometry and surgery, odds of falling within 90 days of biometry, and estimated delay in days associated with physician testing behavior .Of 248,345 beneficiaries, 16.4% were patients of high-testing physicians. More patients of high-testing physicians waited >30 days and >90 days to have cataract surgery (31.4% and 8.2% versus 25.0% and 5.5%, respectively, p<0.0001 for both). Falls before cataract surgery in patients of high-testing physicians increased by 43% within the 90 days following 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% 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, 95% CI 6.40-9.55, p<0.0001). Other factors associated with delayed surgery included patient race (non-white), northeast geographic region, ophthalmologist age≤40, and low surgical volume.Overuse of routine preoperative medical testing by high-testing physicians is associated with delayed surgery and increased falls in cataract patients awaiting surgery.