Does a 78-year-old patient require blood work prior to eye surgery?

Preoperative Blood Work for 78-Year-Old Undergoing Eye Surgery

Routine preoperative blood work is not required for a 78-year-old patient undergoing eye surgery, as multiple high-quality studies demonstrate no reduction in perioperative complications with routine laboratory testing before cataract and other ophthalmic procedures. 1, 2

Evidence Against Routine Testing

The strongest evidence comes from a landmark randomized controlled trial of over 19,000 cataract operations, which found no difference in intraoperative or postoperative medical complications between patients who underwent routine preoperative testing (ECG, CBC, electrolytes, renal function, glucose) versus those who did not 2. The overall complication rate was identical at 31.3 events per 1000 operations in both groups 2.

This finding has been reinforced by:

• A 2023 systematic review of 48,869 eyes confirming that routine preoperative testing did not decrease adverse events or perioperative complications in most ophthalmic surgery patients 3
• American Family Physician guidelines explicitly stating that patients in their usual state of health undergoing cataract surgery do not require preoperative testing 1
• The American Academy of Ophthalmology's 2022 Preferred Practice Pattern noting that three randomized trials failed to show that preoperative medical evaluation reduces systemic or ocular complications 1

When Blood Work IS Indicated

However, directed testing should be obtained if specific clinical conditions are present 1:

Check hemoglobin/hematocrit if:

• The patient has known anemia or symptoms suggesting anemia 1
• There is a history of conditions associated with anemia 1
• The Association of Anaesthetists recommends knowing the hemoglobin concentration before surgery in patients over 75 years as part of their surgical safety checklist 1

Check renal function (eGFR) if:

• The patient has known kidney disease 1
• The patient is on medications requiring renal dose adjustment 1
• The Association of Anaesthetists recommends knowing eGFR in patients over 75 years undergoing surgery 1

Check glucose if:

• The patient has known diabetes requiring perioperative management adjustment 1
• The patient is at very high risk of undiagnosed diabetes based on history or medications 1

Check coagulation studies only if:

• The patient has liver disease, hematologic disorders, or takes anticoagulants 1
• There is a personal or family history of bleeding disorders 1

Critical Distinction: Major vs. Minor Eye Surgery

The evidence primarily addresses routine cataract surgery, which is low-risk. If this 78-year-old is undergoing more complex ophthalmic surgery requiring general anesthesia or involving significant tissue manipulation, the risk profile changes 1:

• For elderly patients undergoing major surgery with general anesthesia, the Association of Anaesthetists recommends more comprehensive preoperative assessment including hemoglobin and renal function 1
• Pre-operative anemia in elderly surgical patients is associated with myocardial ischemia, falls, and poor wound healing 1

Practical Algorithm

For routine cataract or minor eye surgery:

• No routine blood work needed 1, 2
• Obtain directed testing only based on specific medical conditions as outlined above 1

For complex eye surgery requiring general anesthesia in this 78-year-old:

• Obtain hemoglobin concentration 1
• Obtain eGFR 1
• Consider additional testing based on comorbidities (glucose if diabetic, coagulation studies if on anticoagulants) 1

Common Pitfalls to Avoid

Do not order routine "preoperative panels" reflexively - this adds cost and patient burden without improving safety for most ophthalmic surgery patients 1, 4. The key is distinguishing between routine low-risk eye surgery (where testing is unnecessary) and higher-risk scenarios or patients with specific comorbidities (where targeted testing is appropriate) 3.