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3 - Preoperative testing

Published online by Cambridge University Press:  12 January 2010

By
Nomi L. Traub
Edited by
Michael F. Lubin ,
Robert B. Smith ,
Thomas F. Dodson ,
Nathan O. Spell  and
H. Kenneth Walker
Nomi L. Traub
Affiliation:
Assistant Professor of Medicine, Emory University School of Medicine, 49 Jesse Hill Jr. Drive, Atlanta, GA 30303
Michael F. Lubin
Affiliation:
Emory University, Atlanta
Robert B. Smith
Affiliation:
Emory University, Atlanta
Thomas F. Dodson
Affiliation:
Emory University, Atlanta
Nathan O. Spell
Affiliation:
Emory University, Atlanta
H. Kenneth Walker
Affiliation:
Emory University, Atlanta
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Summary

Overview and historical perspective

The goal of preoperative medical evaluation of patients should be reduction of intraoperative and perioperative morbidity and mortality. A review of the literature suggests this is best acccomplished by a meticulous preoperative history and physical exam. The data gleaned from the history and physical, combined with information about the planned procedure, form the basis for selection of medically indicated preoperative tests.

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. Large-scale routine testing leads to the discovery of numerous minor abnormalities, usually of no importance to surgical care. Further evaluation of these abnormal values may incur additional cost, potential harm to patients from more invasive investigations, and often unnecessary surgical delays.

During the 1970s and 1980s, multiple investigators focused attention on the usefulness and cost-effectiveness of screening laboratory tests. In a landmark article in 1985, Kaplan et al. assessed the value of routine laboratory screening of preoperative patients. He and coworkers studied a random sample of 2000 patients who underwent tests before elective surgery in an academic medical center. They set criteria for test indications and “action limits” for test results.

Type
Chapter
Information
Medical Management of the Surgical Patient
A Textbook of Perioperative Medicine
 , pp. 32 - 39
Publisher: Cambridge University Press
Print publication year: 2006

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References

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