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Preoperative consultations for medicare patients undergoing cataract surgery.

Publication ,  Journal Article
Thilen, SR; Treggiari, MM; Lange, JM; Lowy, E; Weaver, EM; Wijeysundera, DN
Published in: JAMA Intern Med
March 2014

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 (<10%). Variation in frequency of consultation across hospital referral regions was substantial (median [range], 12% [0-69%]), even after accounting for differences in patient-level, anesthesia provider-level, and facility-level characteristics. CONCLUSIONS AND RELEVANCE: Between 1995 and 2006, the frequency of preoperative consultation for cataract surgery increased substantially. Referrals for consultation seem to be primarily driven by nonmedical factors, with substantial geographic variation.

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Published In

JAMA Intern Med

DOI

EISSN

2168-6114

Publication Date

March 2014

Volume

174

Issue

3

Start / End Page

380 / 388

Location

United States

Related Subject Headings

  • United States
  • Risk Factors
  • Retrospective Studies
  • Referral and Consultation
  • Preoperative Care
  • Medicare
  • Male
  • Humans
  • Female
  • Cataract Extraction
 

Citation

APA
Chicago
ICMJE
MLA
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Thilen, S. R., Treggiari, M. M., Lange, J. M., Lowy, E., Weaver, E. M., & Wijeysundera, D. N. (2014). Preoperative consultations for medicare patients undergoing cataract surgery. JAMA Intern Med, 174(3), 380–388. https://doi.org/10.1001/jamainternmed.2013.13426
Thilen, Stephan R., Miriam M. Treggiari, Jane M. Lange, Elliott Lowy, Edward M. Weaver, and Duminda N. Wijeysundera. “Preoperative consultations for medicare patients undergoing cataract surgery.JAMA Intern Med 174, no. 3 (March 2014): 380–88. https://doi.org/10.1001/jamainternmed.2013.13426.
Thilen SR, Treggiari MM, Lange JM, Lowy E, Weaver EM, Wijeysundera DN. Preoperative consultations for medicare patients undergoing cataract surgery. JAMA Intern Med. 2014 Mar;174(3):380–8.
Thilen, Stephan R., et al. “Preoperative consultations for medicare patients undergoing cataract surgery.JAMA Intern Med, vol. 174, no. 3, Mar. 2014, pp. 380–88. Pubmed, doi:10.1001/jamainternmed.2013.13426.
Thilen SR, Treggiari MM, Lange JM, Lowy E, Weaver EM, Wijeysundera DN. Preoperative consultations for medicare patients undergoing cataract surgery. JAMA Intern Med. 2014 Mar;174(3):380–388.

Published In

JAMA Intern Med

DOI

EISSN

2168-6114

Publication Date

March 2014

Volume

174

Issue

3

Start / End Page

380 / 388

Location

United States

Related Subject Headings

  • United States
  • Risk Factors
  • Retrospective Studies
  • Referral and Consultation
  • Preoperative Care
  • Medicare
  • Male
  • Humans
  • Female
  • Cataract Extraction