Book contents
- Frontmatter
- Dedication
- Contents
- List of Contributors
- Preface
- Introduction
- Part 1 Perioperative Care of the Surgical Patient
- Section 1 General
- Chapter 1 Anesthesia management of the surgical patient
- Chapter 2 Specialized nutrition support in the surgical patient
- Chapter 3 Preoperative testing
- Chapter 4 Medication safety for surgical patients
- Chapter 5 Informed consent and decision-making capacity
- Chapter 6 Ethical considerations in the surgical patient
- Chapter 7 Perioperative pain management
- Chapter 8 The medical consult
- Section 2 Cardiology
- Section 3 Hypertension
- Section 4 Pulmonary
- Section 5 Gastroenterology
- Section 6 Hematology
- Section 7 Infectious disease
- Section 8 Renal disease
- Section 9 Endocrinology
- Section 10 Rheumatology
- Section 11 Neurology
- Section 12 Surgery in the Elderly
- Section 13 Obesity
- Section 14 Transplantation
- Section 15 Psychiatric Disorders
- Section 16 Peripartum Patients
- Part 2 Surgical Procedures and their Complications
- Index
- References
Chapter 3 - Preoperative testing
from Section 1 - General
Published online by Cambridge University Press: 05 September 2013
- Frontmatter
- Dedication
- Contents
- List of Contributors
- Preface
- Introduction
- Part 1 Perioperative Care of the Surgical Patient
- Section 1 General
- Chapter 1 Anesthesia management of the surgical patient
- Chapter 2 Specialized nutrition support in the surgical patient
- Chapter 3 Preoperative testing
- Chapter 4 Medication safety for surgical patients
- Chapter 5 Informed consent and decision-making capacity
- Chapter 6 Ethical considerations in the surgical patient
- Chapter 7 Perioperative pain management
- Chapter 8 The medical consult
- Section 2 Cardiology
- Section 3 Hypertension
- Section 4 Pulmonary
- Section 5 Gastroenterology
- Section 6 Hematology
- Section 7 Infectious disease
- Section 8 Renal disease
- Section 9 Endocrinology
- Section 10 Rheumatology
- Section 11 Neurology
- Section 12 Surgery in the Elderly
- Section 13 Obesity
- Section 14 Transplantation
- Section 15 Psychiatric Disorders
- Section 16 Peripartum Patients
- Part 2 Surgical Procedures and their Complications
- Index
- References
Summary
Overview and historical perspective
Preoperative evaluation of patients is a unique opportunity to assess patients who may not have previously been in contact with primary care with the principal goal of intraoperative and postoperative risk reduction. New diagnoses may be identified, or perhaps more frequently, chronic conditions medically optimized in preparation for surgery. In all cases, a meticulous preoperative history and physical exam will be performed. The data gleaned from the history and physical exam, combined with information about the planned procedure, form the basis for selection of medically indicated preoperative tests.
Preoperative evaluation and testing theory has evolved greatly over the last 50 years. Routine preoperative testing for all patients, rather than indicated testing for selected patients, came into vogue with the advent of multiphasic screening in the 1960s. The alluring notion that routine testing would lead to the discovery and treatment of unsuspected abnormalities, thereby decreasing perioperative complications, has not been realized. In a landmark 1985 study, Kaplan et al. assessed the value of routine laboratory screening of preoperative patients. In a random sample of 2,000 patients who underwent tests before elective surgery in an academic medical center, Kaplan's group found there was no indication for 60% of the preoperative tests that were performed. Only 3.4% of these tests were abnormal and very few of these tests (0.14%) were potentially significant [1]. Moreover, even though none of these potentially significant results was acted on and no changes in patient care resulted, Kaplan showed that no complications resulted.
- Type
- Chapter
- Information
- Medical Management of the Surgical PatientA Textbook of Perioperative Medicine, pp. 26 - 31Publisher: Cambridge University PressPrint publication year: 2013