A preoperative evaluation (or “preoperative exam”) is a visit you have before surgery. Your care team reviews your overall health to identify risk factors, optimize health, and endsure patient safety.
At your appointment, your provider reviews your medical history, allergies, and current medications and completes a focused physical exam. Depending on your health and the type of surgery, they may also recommend tests to help your team prepare.
Pre-Operative Evaluation Makes Surgery Safer
At some point, you or someone you love will require surgery and anesthesia. It’s normal to feel nervous. The good news is that anesthesia and surgery are much safer today than they were in the past. Over many years, doctors and nurses learned—through research, training, and improved monitoring—how to lower risks and keep patients as safe as possible.
After you discuss the surgery and its timing with your surgeon, he will request you obtain preoperative evaluation. This is done at your primary care doctors office by him/her or members of the staff. Most of the time this is done in the office at least 2 weeks ahead of time. Some organizations recommend 4 to 6 weeks ahead of the surgery whereas others, such as the NIH (National Institute of Health), suggests evaluations closer to surgery to improve peri-operative outcomes. Follow the guidelines set by your surgeon and primary care giver.
A preoperative evaluation (your pre-surgery checkup) is one of the most important steps in helping your procedure go smoothly and safely. This evaluation ensures there is no medical condition that would affect the surgery.
What to expect
- Questions about your health conditions and past surgeries
- A review of your medications, vitamins, and supplements
- A brief physical exam (for example, listening to your heart and lungs)
- Possible lab work, an EKG, or other tests—only if your provider recommends them
Surgery and anesthesia are very safe for most people today. A pre-op exam helps your team understand your health needs and plan the safest approach for you.
Why a preoperative exam matters
- Identifies health conditions that could affect surgery or recovery
- Helps your care team choose the safest anesthesia plan
- Reviews medications to avoid interactions and reduce bleeding risk
- Determines whether any testing is needed before your procedure
Pre-op evaluations are often recommended for patients having surgery to confirm there are no medical concerns that need attention beforehand.
How to prepare
- Bring a current list of all medications, vitamins, and supplements (or the bottles)
- Know your allergies and past reactions to anesthesia
- Have contact information for your surgeon and pharmacy
- Bring copies of recent test results if you have them
- Write down questions you’d like to ask
A thorough preoperative evaluation helps identify underlying medical conditions—such as heart disease, diabetes, or respiratory issues—that could increase the risk of complications during or after surgery. Early detection allows for timely interventions to optimize the patient’s condition before surgery
The preoperative evaluation identifies any condition that may affect your outcome. It allows healthcare providers to customize the surgical and anesthetic plan based on the patient’s unique health profile, including allergies, medications, and previous surgeries. To accomplish this the person in charge of your evaluation will obtain a medical history and perform a physical examination. Based on this information they will decide to perform other testing.
During this evaluation the anesthesia team looks for any medical conditions that may affect the anesthetic. Some of the more common conditions that will require special attention are as follows:
- Heart Disease
- Kidney Disease
- Previous stroke
- Complications with anesthesia
- Lung Disease such as emphysema or asthma
It is important to address these medical conditions, to ensure they are stable and not a problem during the procedure.
Blood Work
Electrolyte and creatinine testing should be performed in patients with underlying chronic disease and those taking medications that predispose them to electrolyte abnormalities or renal failure. Examples would include patients with renal disease or those who use meds which affect electrolytes.
Random glucose testing should be performed in patients at high risk of undiagnosed diabetes mellitus. In patients with diagnosed diabetes, A1C testing is recommended only if the result would change perioperative management.
A complete blood count is indicated for patients with diseases that increase the risk of anemia or patients in whom significant perioperative blood loss is anticipated. This would include all who may face a blood loss of more than a liter or someone who tends to be anemic. Examples would include patients with renal disease, cancer or liver disease.
Coagulation studies are reserved for patients with a history of bleeding or medical conditions that predispose them to bleeding, and for those taking anticoagulants. It would also be required for neurosurgery and cardiac surgery.
Urine Tests
Preoperative urinalysis is recommended for patients undergoing invasive urologic procedures and those undergoing implantation of foreign material. It would also include those with urinary symptoms.
Patients in their usual state of health who are undergoing cataract surgery do not require preoperative testing.
Special Tests
Electrocardiography is recommended by most organizations for patients undergoing high-risk surgery and those undergoing intermediate-risk surgery who have additional risk factors. This must be performed 1-3 months before the procedure. Patients undergoing low-risk surgery do not require electrocardiography.
Chest radiography is reasonable for patients at risk of postoperative pulmonary complications if the results would change perioperative management. It is advisable for those who have signs or symptoms of cardiopulmonary disease.
The testing will help to complement the history and physical to determine if there are risks to the patient. With this information they can implement measures to safeguard the patient. Studies show that up to 60% of surgical complications are preventable with proper preoperative planning. This includes avoiding infections, managing blood pressure and blood sugar levels, and ensuring proper nutrition. This can also help decrease the length of hospital stay as well as minimize postponed or cancelled surgeries.
