Author Block: Verina Hanna, Marko M. Popovic, Ravin Alaei, Sherif El-Defrawy, Matthew B. Schlenker, Peter J. Kertes

Disclosure Block: V. Hanna: None. M.M. Popovic: None. R. Alaei: None. S. El-Defrawy: None. M.B. Schlenker: Any direct financial payments including receipt of honoraria; Name of for-profit or not-for-profit organization(s); Allergan, Light Matter Interaction, Santen. Any direct financial payments including receipt of honoraria; Description of relationship(s); Consultant/consulting fees. Membership on advisory boards or speakers’ bureaus; Name of for-profit or not-for-profit organization(s); Allergan, Bausch Health, Johnson & Johnson Vision, Théa-Labtician. Membership on advisory boards or speakers’ bureaus; Description of relationship(s); speaker honoraria. P.J. Kertes: Membership on advisory boards or speakers’ bureaus; Name of for-profit or not-for-profit organization(s); Novartis, Alcon, Bayer, Allergan, Novelty Nobility. Membership on advisory boards or speakers’ bureaus; Description of relationship(s); Advisory board, Scientific advisory board. Funded grants or clinical trials; Name of for-profit or not-for-profit organization(s); Allergan, Bayer, Roche, Novartis. Funded grants or clinical trials; Description of relationship(s); Financial support to institution, Financial support. All other investments or relationships that could be seen by a reasonable, well-informed participant as having the potential to influence the content of the educational activity; Name of for-profit or not-for-profit organization(s); ArcticDx. All other investments or relationships that could be seen by a reasonable, well-informed participant as having the potential to influence the content of the educational activity; Description of relationship(s); Equity owner.

Purpose: To determine whether routine preoperative assessment impacts the rate of medical and surgical complications in patients undergoing ophthalmic surgery.
Study Design: Systematic review.
Methods: A search of Ovid MEDLINE, EMBASE, and Cochrane CENTRAL was conducted to identify relevant articles published between 2000 and March 2020. Original articles investigating preoperative assessments performed by any healthcare professional prior to ophthalmic surgery were included. For each study, the rates of perioperative ocular and systemic complications were reported using descriptive statistics.
Results: A total of 10 805 articles were identified, of which nine studies were selected for inclusion. Overall, four studies were randomized controlled trials (RCTs) and five were observational studies. Eight studies reported on cataract surgery and one on vitreoretinal surgery. In two studies, the preoperative assessment consisted of a patient-administered questionnaire, while the remaining studies involved a combination of history, physical examination, laboratory testing, electrocardiogram, chest x-ray, and other investigations. Preoperative testing in routine settings did not decrease the rates of adverse events or the risk of perioperative ocular and systemic complications in any study. Two studies suggested that patients with pre-existing hypertension, congestive heart failure, coronary artery disease, arrhythmia, diabetes, anemia, pulmonary disease, or renal disease were at a higher risk for adverse events perioperatively. Patients with pre-existing comorbidities who underwent preoperative testing had a lower risk of complications in one study, while no difference was found in another. Risk of bias assessment generally revealed a lack of masking in RCTs and confounding of effect in observational studies.
Conclusions: Across 48 869 eyes, routine preoperative medical testing prior to ophthalmic surgery did not reduce the rate of perioperative ocular or systemic surgical complications. Patients with certain pre-existing comorbidities may be at an increased risk of developing adverse events, and the role of preoperative testing is not well delineated in this population. Further studies are required to determine whether these conclusions are true across diverse subspecialties and to determine the comparative safety, effectiveness, and implementation of alternative preoperative assessment tools.