College of Population Health (Dr. Kaminski) and Sidney Kimmel Medical College (Ms. Venkat), Thomas Jefferson University, Philadelphia, PA mitchell.kaminski@jefferson.edu
The authors reported no potential conflict of interest relevant to this article.
The American Society of Anesthesiologists (ASA) Physical Status Classification System, which has been in use for more than 60 years, considers the patient’s physical status (ASA grades I-VI),24 and when paired with surgery grades of minor, intermediate, and major/complex, can help assess preoperative risk and guide preoperative testing (TABLE).24-26
Preoperative medical testing did not reduce the risk of medical adverse events during or after cataract surgery when compared with selective or no testing.27 Unnecessary preoperative testing can lead to a nonproductive cascade of additional investigations. In a 2018 study of Medicare beneficiaries, unnecessary routine preoperative testing and testing sequelae for cataract surgery was calculated to cost Medicare up to $45.4 million annually.28
CASE
You would not be practicing value-based laboratory testing, according to the USPSTF, if you ordered a CMP, fasting lipid profile, and TSH and 25(OH) vitamin D tests for this healthy 35-year-old man whose family history, blood pressure, and BMI do not put him at elevated risk. Universal lipid screening (Grade Ba) is recommended for all adults ages 40 to 75. Thyroid screening tests and measurement of 25(OH) vitamin D level (I statementsa) are not recommended. The USPSTF has not evaluated chemistry panels for screening.
The USPSTF would recommend the following actions for this patient:
Screen for HIV (ages 15 to 65 years; and younger or older if patient is at risk). (A recommendationa,29)
Screen for hepatitis C virus (in those ages 18 to 79). (Brecommendation30)
The following USPSTF recommendations might have come into play if this patient had certain risk factors, or if the patient had been a woman:
Screen for diabetes if the patient is overweight or obese (B recommendation).
Screen for hepatitis B in adults at risk (B recommendation).
Screen for gonorrhea and chlamydia in women at risk (B recommendation). Such screening has an “I”statement for screening men at risk.
