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Chapter 3 - Preoperative testing

from Section 1 - General

Published online by Cambridge University Press:  05 September 2013

By
Eva Rimler  and
Danielle Jones
Edited by
Michael F. Lubin ,
Thomas F. Dodson  and
Neil H. Winawer
Michael F. Lubin
Affiliation:
Emory University, Atlanta
Thomas F. Dodson
Affiliation:
Emory University, Atlanta
Neil H. Winawer
Affiliation:
Emory University, Atlanta
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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 Patient
A Textbook of Perioperative Medicine
 , pp. 26 - 31
Publisher: Cambridge University Press
Print publication year: 2013

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