Level 1: Likely reliable evidence

A recent Cochrane review of three randomized trials evaluated the addition of routine medical testing to standard preoperative history and physical exams prior to age-related cataract surgery. Routine preoperative testing included ECG; complete blood count; electrolyte, blood urea nitrogen, creatinine, and blood glucose determinations, regardless of indications. In 21,531 operations, there were 707 surgery-associated medical adverse events (mostly cardiovascular), including 61 hospitalizations and three deaths. Routine testing was not associated with decreased risk for medical adverse events compared with selective or no testing. There were no significant differences in intraoperative medical adverse events (2.25% vs. 2.21%), postoperative adverse events (1.13% vs. 1.18%), or surgery cancellations (1.57% vs. 1.61%). Routine testing was associated with higher costs in the only trial that evaluated cost-effectiveness (Cochrane Database Syst Rev. 2009;[2]:CD007293).