Preoperative medical testing and falls in Medicare beneficiaries awaiting cataract surgery.

ABSTRACT Objective 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. Design 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. Main Outcome Measures 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 . Results 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 Conclusions Overuse of routine preoperative medical testing by high-testing physicians is associated with delayed surgery and increased falls in cataract patients awaiting surgery.