Preoperative Screening Questionnaire for Common Eye Surgeries Safely Reduces the Need for Comprehensive History & Physical Examinations.

Abstract

Purpose: To evaluate the safety and utility of a brief preoperative patient questionnaire (PQ) in reducing the need for a comprehensive history and physical (H&P) in patients undergoing cataract and similar eye surgeries.

Design: Observational Cohort Study PARTICIPANTS: All patients (n=7352) scheduled for anterior segment surgeries (n=11469) at an ambulatory surgical center from 6/1/2021 to 12/31/2024.

Methods: The PQ was developed collaboratively by physicians with relevant content expertise. It was administered by scheduling staff, initially to a pilot cohort and then systematically, to stratify patients based on medical risk. Patients with negative responses to all the questions ("PQ-pass") bypassed the H&P and presented directly on the day of surgery, while others ("PQ-fail" and "PQ-not-administered") needed to obtain a preoperative H&P within 60 days of the surgery. Patient demographics, surgical scheduling details, and PQ outcomes were recorded as well as day-of-surgery cancellations and emergency department (ED) transfers. Analyses were performed using cluster-adjusted linear regression, logistic regression via generalized estimating equations (GEE) with clustering by patient, and bootstrapped quantile (median) regression.

Main outcome measures: Rates of day-of-surgery cancellations for medical reasons, ED transfers, and the time from case creation to the date of surgery.

Results: The PQ was administered for 4418 surgeries (2881 patients), with 81% passing it and bypassing a preoperative H&P. The cancellation rate for medical reasons was lower in the PQ-pass group (0.6%) compared with the PQ-not-administered group (1.7%, P<0.001) and the PQ-fail group (1.4%, P=0.07). ED transfer rates were almost non-existent and similar across groups. Compared to the PQ-fail group, the PQ-pass group had a significantly shorter time-to-surgery (14 days, P<0.001). Multivariate analysis identified older age, Black race, American Society of Anesthesiologists (ASA) class III or IV, and non-cataract surgeries as factors associated with failing the PQ.

Conclusions: Most patients undergoing outpatient eye surgery under monitored anesthesia care can safely bypass a comprehensive preoperative H&P. These patients can be identified using a brief questionnaire. This approach is safe, has low day-of-surgery cancellation rates, quicker time-to-surgery, and substantially reduces patient, staff, and payor burden.