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PREOPERATIVE ASSESSMENT INVESTIGATIONS

Preoperative assessment 

Clinical assessment, including a cardiac, pulmonary and nutritional assessment. The nature and extent of the proposed surgery will determine the direction and extent of preoperative investigations, including laboratory testing.

Preoperative laboratory studies once routinely included an FBC, extensive blood 
chemistry profile, urinalysis, PI, PTT, ECG and CXR. Numerous studies have subsequently shown that most of these tests were ordered without a clear indication, and only a very small percentage of the results were unexpectedly abnormal. 

Current recommendations call for fewer routine tests and for selective ordering of laboratory tests based on the specific indications in a patient.

 

CONDITION 

INDICATED TESTING AND OTHER MEASUREMENTS

Healthy patient

 

< = 40 years

Haemoglobin - to detect unsuspected 
anaemia and providing a baseline level, which can be helpful postoperatively, particularly for surgeries with potential haemorrhagic complications.
Urine screening for pregnancy (β-HCG) 
in women of childbearing potential

> 40 years

Haemoglobin
Blood glucose (> = 45 years) - the presence 
of diabetes mellitus increases perioperative risks.
ECG

Cardiovascular disease

ECG
CXR
Haemoglobin
Blood glucose
U & E, creatinine

Recent MI (<=6 weeks) unstable angina, decompenstated CCF, significant arrhythmias, severe valvular disease.

Cardiac consultation

Previous MI (> 6 weeks ago), mild stable angina, compensated CCF, diabetes mellitus

Stress ECG if high-risk procedure or patient has low functional capacity

Rhythm other than normal sinus rhythm, abnormal ECG, history of stroke, advanced age, low functional capacity

Stress ECG if high-risk procedure and patient has low functional capacity

Pulmonary disease

CXR
Haemoglobin 
Blood glucose
(> = 45 years) Provide patient with instructions for incentive spirometry or deep-breathing exercises.

Asthma

Pulmonary function testing or peak flow rate to assess disease status.

COPD

Consider pulmonary function testing and blood gas analysis for assessment of disease severity.

Cough 

Evaluate for aetiology

Dyspnea

Evaluate for aetiology

Smoking

Counsel patient to stop smoking 4 - 8 weeks before surgery

Obesity

Provide patient with instructions for incentive spirometry or deep-breathing exercises.

Abdominal or thoracic surgery

Provide patient with instructions for incentive spirometry or deep-breathing exercises.

Malnutrition

Protein and albumin FBC

Other 

Coagulation studies - these are not routinely indicated. Coagulation studies would be indicates in patients receiving anticoagulant therapy, has a family or personal history that suggests a bleeding disorder or has evidence of liver disease.  
Blood x-match - if a requirement for transfusion is likely.
HIV serology - if HIV testing is deemed necessary, specific consent must first be obtained from the patient.
Potassium - in patients on diuretics
Malignant hyperthermia PCR - CK and 
standard muscle biopsy are not reliable tests for this disorder.

 

REFERENCES

  1. Marcella PW et al. "Routine" preoperative studies: which studies in which patients? Surg Clin North Am 1996; 76: 11- 23
  2. Kaplan EB et al. The usefulness of preoperative laboratory screening. JAMA 1985; 253: 3576 - 81
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