Oral anxiolytics prior to routine resident cataract surgery eliminate need for intravenous sedation at a Veterans Affairs Hospital

PURPOSE: To assess the frequency of intraoperative intravenous sedation administration during routine resident-performed cataract surgery among patients receiving pre-operative oral sedation at a Veterans Affairs Medical Center and its impact on patient safety and system cost. METHODS: Retrospective review of all resident-performed cataract surgeries performed at the Iowa City Veterans Affairs Medical Center in 2013 and 2017. Cases monitored by a registered nurse were included. Combined cases and cases monitored by an anesthesia provider were excluded. Pre-operative placement of an intravenous (IV) catheter, administration of intra-operative IV sedation, oral diazepam administration, anesthesia type, conditions for administering intraoperative IV medication, and cost of IV catheter placement were recorded. RESULTS: Of 1025 patient cases included for analysis, 972 received pre-operative diazepam (94.9%) and 1017 (99.3%) had IV catheters placed. One patient received a planned dose of IV methylprednisolone. Zero patients received supplemental intraoperative IV sedation. The estimated materials cost of unused IV catheters was $10,668 over 2 years. CONCLUSIONS: Pre-operative IV catheter placement may not be necessary in patients undergoing routine resident cataract surgery with pre-operative oral sedation. Discontinuation of routine IV placement may improve patient satisfaction and decrease health care costs without compromising patient safety.