Importance In 2019, the US Centers for Medicare & Medicaid Services implemented the Patients Over Paperwork initiative, allowing hospitals and ambulatory surgery centers to establish their own policies on preoperative history and physical requirements. A risk-based approach to preoperative medical evaluation may allow surgeons to provide high-value patient care.

Objective To assess the feasibility of a risk-based approach to cataract surgery preoperative medical evaluation through a lens of safety and throughput.

Design, Setting, and Participants A pilot study was performed to evaluate the implementation of a risk-based approach to preoperative medical evaluation for cataract surgery using a virtual medical history questionnaire. The intervention group, seen from June to September 2020, received the risk assessment and those who were low risk proceeded to surgery without further preoperative evaluation prior to the day of surgery. The preintervention control group included patients who received standard care from January to December 2019.

Main Outcomes and Measures Primary outcomes included rates of intraoperative complications, noneye-related emergency department visits within 7 days, inpatient admissions within 7 days of surgery, case delays, and rates of case cancellation. The secondary outcome included patient perception regarding preoperative care.

Results A total of 1095 patients undergoing cataract surgery were included in the intervention group (1813 [58.2%] female) and 3114 were in the control group (621/1095 [56.7%] female). The mean (SD) age was 68.6 (11.0) in the control group and 68.4 (10.5) in the intervention group. The intervention group included 126 low-risk individuals (11.5%) and 969 individuals who received standard care (88.5%). There were no differences between the control and intervention groups in terms of rates of intraoperative complications (control group vs intervention group: 21 [0.7%] vs 3 [0.3%]; difference, −0.4% [95% CI, −0.82 to 0.02]), 7-day noneye-related ED visits (5 [0.2%] vs 3 [0.3%]; difference, 0.1% [95% CI, −0.23 to 0.45]), 7-day inpatient admissions (6 [0.2%] vs 2 [0.2%]; difference, −0.01% [95% CI, −0.31 to 0.29]), or same-day cancellations (31 [0.8%] vs 10 [0.6%]; difference, −0.15% [95% CI, −0.63 to 0.34]). The control group had more case delays (59 [1.9%] vs 7 [0.6%]; difference, −1.3% [95% CI, −1.93 to −0.58]).

Conclusions and Relevance This study suggests that a virtual, risk-based approach to preoperative medical evaluations for cataract surgery is associated with safe and efficient outcomes. These findings may encourage health care systems and ambulatory surgery centers to tailor preoperative requirements for low-risk surgery patients.

重要性 2019 年，美国医疗保险和医疗补助服务中心实施了“患者重于文书工作”倡议，允许医院和门诊手术中心制定自己的术前病史和身体要求政策。基于风险的术前医学评估方法可以让外科医生提供高价值的患者护理。

目的 从安全性和吞吐量的角度评估基于风险的白内障手术术前医学评估方法的可行性。

设计、设置和参与者 进行了一项试点研究，以使用虚拟病史问卷评估白内障手术术前医学评估基于风险的方法的实施情况。干预组于 2020 年 6 月至 2020 年 9 月接受风险评估，低风险者在手术当天之前无需进一步的术前评估就进行了手术。干预前对照组包括从 2019 年 1 月至 2019 年 12 月接受标准护理的患者。

主要结果和措施 主要结果包括术中并发症发生率、7 天内非眼科急诊就诊、手术后 7 天内入院、病例延误和病例取消率。次要结果包括患者对术前护理的看法。

结果 干预组共纳入1095例白内障手术患者（1813例[58.2%]女性），对照组3114例（621/1095[56.7%]女性）。对照组的平均 (SD) 年龄为 68.6 (11.0)，干预组为 68.4 (10.5)。干预组包括 126 名低风险个体 (11.5%) 和 969 名接受标准护理的个体 (88.5%)。对照组和干预组的术中并发症发生率无差异（对照组与干预组：21 [0.7%] vs 3 [0.3%]；差异，-0.4% [95% CI，-0.82 至 0.02 ]），7 天非眼相关 ED 就诊（5 [0.2%] vs 3 [0.3%]；差异，0.1% [95% CI，-0.23 至 0.45]），7 天住院（6 [0.2%] ] vs 2 [0.2%]；差异，-0.01% [95% CI，-0.31 到 0.29]）或当天取消（31 [0.8%] vs 10 [0. 6%]；差异，-0.15% [95% CI，-0.63 至 0.34]）。对照组的病例延迟更多（59 [1.9%] vs 7 [0.6%]；差异，-1.3% [95% CI，-1.93 至 -0.58]）。

结论和相关性 本研究表明，对白内障手术的术前医学评估采用基于风险的虚拟方法与安全有效的结果相关。这些发现可能会鼓励医疗保健系统和门诊手术中心为低风险手术患者量身定制术前要求。