Preoperative consultations for medicare patients undergoing cataract surgery

Stephan R. Thilen, Miriam Treggiari, Jane M. Lange, Elliott Lowy, Edward M. Weaver, Duminda N. Wijeysundera

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

IMPORTANCE: Low-risk elective surgical procedures are common, but there are no clear guidelines for when preoperative consultations are required. Such consultations may therefore represent a substantial discretionary service. OBJECTIVE: To assess temporal trends, explanatory factors, and geographic variation for preoperative consultation in Medicare beneficiaries undergoing cataract surgery, a common low-risk elective procedure. DESIGN, SETTING, AND PARTICIPANTS: Cohort study using a 5% national random sample of Medicare part B claims data including a cohort of 556 637 patients 66 years or older who underwent cataract surgery from 1995 to 2006. Temporal trends in consultations were evaluated within this entire cohort, whereas explanatory factors and geographic variation were evaluated within the 89 817 individuals who underwent surgery from 2005 to 2006. MAIN OUTCOMES AND MEASURES: Separately billed preoperative consultations (performed by family practitioners, general internists, pulmonologists, endocrinologists, cardiologists, nurse practitioners, or anesthesiologists) within 42 days before index surgery. RESULTS: The frequency of preoperative consultations increased from 11.3%in 1998 to 18.4% in 2006. Among individuals who underwent surgery in 2005 to 2006, hierarchical logistic regression modeling found several factors to be associated with preoperative consultation, including increased age (75-84 years vs 66-74 years: adjusted odds ratio [AOR], 1.09 [95% CI, 1.04-1.13]), race (African American race vs other: AOR, 0.71 [95% CI, 0.65-0.78]), urban residence (urban residence vs isolated rural town: AOR, 1.64 [95% CI, 1.49-1.81]), facility type (outpatient hospital vs ambulatory surgical facility: AOR, 1.10 [95% CI, 1.05-1.15]), anesthesia provider (anesthesiologist vs non-medically directed nurse anesthetist: AOR, 1.16 [95% CI, 1.10-1.24), and geographic region (Northeast vs South: AOR, 3.09 [95% CI, 2.33-4.10]). The burden of comorbidity was associated with consultation, but the effect size was small (

Original languageEnglish (US)
Pages (from-to)380-388
Number of pages9
JournalJAMA Internal Medicine
Volume174
Issue number3
DOIs
StatePublished - 2014
Externally publishedYes

Fingerprint

Medicare
Cataract
Referral and Consultation
Odds Ratio
Geography
Medicare Part B
Elective Surgical Procedures
Nurse Anesthetists
Nurse Practitioners
African Americans
General Practitioners
Comorbidity
Cohort Studies
Outpatients
Anesthesia
Logistic Models
Outcome Assessment (Health Care)
Guidelines

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Preoperative consultations for medicare patients undergoing cataract surgery. / Thilen, Stephan R.; Treggiari, Miriam; Lange, Jane M.; Lowy, Elliott; Weaver, Edward M.; Wijeysundera, Duminda N.

In: JAMA Internal Medicine, Vol. 174, No. 3, 2014, p. 380-388.

Research output: Contribution to journalArticle

Thilen, Stephan R. ; Treggiari, Miriam ; Lange, Jane M. ; Lowy, Elliott ; Weaver, Edward M. ; Wijeysundera, Duminda N. / Preoperative consultations for medicare patients undergoing cataract surgery. In: JAMA Internal Medicine. 2014 ; Vol. 174, No. 3. pp. 380-388.
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